Form Q1 1105 - Quarterly Estimate
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1RETURN WITH PAYMENT
FORM Q1
1105
QUARTERLY ESTIMATE
MAKE CHECK OR MONEY ORDER TO:
City of Tiffin Income Tax Dept.
AMOUNT
}
MAIL
CITY OF TIFFIN INCOME TAX DEPT.
P.O. BOX 518
ENCLOSED $
TO
TIFFIN OH 44883
PAID CHECK WILL BE YOUR RECEIPT
Check No:
If receipt is desired, return both copies of this statement with
a self-addressed stamped envelope.
_____Quarter 2017
Voice 419-448-5405
Fax 419-448-5406
DO NOT REMIT CASH BY MAIL
ESTIMATED TAX
TOTAL UNDER PAID
TOTAL AMOUNT CREDITED
AMOUNT OF
QUARTERLY
DECLARED
ESTIMATE PENALTY
UNPAID BALANCE
INSTALLMENT DUE
AMENDED ESTIMATED TAX
Name
DUE ON OR BEFORE
And
Address
TAX ID
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE.
IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE - INCOME TAX OFFICE - PROMPTLY
KEEP FOR YOUR RECORDS
FORM Q1
1105
QUARTERLY ESTIMATE
MAKE CHECK OR MONEY ORDER TO:
City of Tiffin Income Tax Dept.
AMOUNT
}
CITY OF TIFFIN INCOME TAX DEPT.
MAIL
P.O. BOX 518
ENCLOSED $
TO
TIFFIN OH 44883
PAID CHECK WILL BE YOUR RECEIPT
Check No:
If receipt is desired, return both copies of this statement with
a self-addressed stamped envelope.
_____Quarter 2017
Voice 419-448-5405
Fax 419-448-5406
DO NOT REMIT CASH BY MAIL
ESTIMATED TAX
TOTAL UNDER PAID
TOTAL AMOUNT CREDITED
AMOUNT OF
QUARTERLY
DECLARED
ESTIMATE PENALTY
UNPAID BALANCE
INSTALLMENT DUE
AMENDED ESTIMATED TAX
Name
DUE ON OR BEFORE
And
Address
TAX ID
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE.
IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE - INCOME TAX OFFICE - PROMPTLY
DUE DATES:
1ST QTR: April 18, 2017
2ND QTR:
June 15, 2017
3RD QTR: Sept 15, 2017
4TH QTR:
Dec 15, 2017
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