Form R-ind - Dayton - 2000

2000 Form R-Ind
Records in our office indicate you are required to file a return based on your residence during the past year. Though you may not owe it is
required that you complete and file an income tax form with our office. Once you have completed the information below please mail or FAX
this form and attachments to our office. Our FAX number is (937) 333-4280. Please read all lines carefully and include all information
requested. All returns should be signed and dated. If your status as a taxpayer has changed and you require a complete forms
package please contact our office at (937) 333-3501. For fastest service visit out web site at
Account Number
Spouse’s Name
City, State, Zip Code
_____________ All tax withheld by my employer(s). Attach all wage statements. (Forms W-2)
_____________ I live and work outside all taxing jurisdictions listed at the bottom of this form.
_____________ Retired ___________. Only source of income is from __________________.
(List Source)
_____________ Business ceased operation effective_________________________________.
_____________ Rental or business sold________________to __________________________
_____________ Active duty military pay is my only source of income. Attach wage Statement. (Form W-2)
_____________ If you moved during 2000 list: Date Moved_____________ and Old Address____________________
The undersigned declare this return (and accompanying schedules) is a true and complete return for the taxable period stated.
Your Signature
Spouse’s Signature (Joint Return)
Mailing Address:
Office Location:
Phone # (937) 333-3500
City of Dayton
Department of Finance
Forms # (937) 333-3501
Division of Revenue and Taxation
Division of Revenue and Taxation
(937) 333-4280
PO Box 2806
101 West Third Street
Dayton, Ohio 45401-2806
Dayton, Ohio 45402
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Parent category: Financial