Form Ir-22 - City Income Tax Return For Individuals - 2012
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1
2
3Staple W-2’s to the back of this page
2012
IR-22
City of Columbus, Income Tax Division
City Income Tax Return For Individuals
Check the appropriate box if:
Primary Social Security Number
(An amount must be placed in
REFUND
Last Name
Line 6B for this return to be
First name and Middle Initial
Spouse's Social Security Number
considered a valid refund request)
AMENDED
tax year
If a joint return, spouse's first name and initial
Last Name
Married-Filing
Married-Filing
Single
Filing Status:
Jointly
Separatly
Home Address (number and street)
YES
NO
•Did you change residence during 2012?
0
If YES, enter date of move
State
City
Zip Code
•Should your account be inactivated?
YES
NO
Attach all forms W-2 and applicable Federal schedules and/or documentation - TO BACK
If YES, explain
Employer(s) and address where work performed
Part A
TAXABLE WAGES
YES
NO
(see Page 2 for Adjustments to Taxable Wages)
•Did you file a City return in 2011?
#2
City(ies) of income #1
•
(+)
$
City of Residence
•
Occupation or nature of business:
•
(+)
$
City
Tax
City
Tax
City
Code
Rate
City
Code
Rate
Columbus
01
2.5%
Harrisburg
(UFR)
16
1.0%
ADJUSTMENTS
(-)
$
Brice
14
2.0%
Marble Cliff
(UFR)
13
2.0%
Obetz
10
2.0%
Canal Winchester
11
2.0%
Groveport
09
2.0%
UFR = Universal Filing Requirement of
NET WAGES (enter in Column B below)
(=)
$
all residents of this community
Part B
2012 TAX CALCULATION
If you file with more than two cities, call 645-7370 and request Form IR-25.
Column A
Column B
Column C
Column D
Column E
Column F
Column G
C
TAX
LESS TAX WITHHELD (W-2),
INCOME FROM
INCOME FROM NET
O
TOTAL
TAX DUE
NET TAX DUE
WAGES, SALARIES,
PROFITS, RENTS
RATE
CITY
PAID BY A PARTNERSHIP OR
D
NET TAXABLE
COMMISSIONS ETC.
AND OTHER TAXABLE
PAID DIRECTLY TO CITY
E
INCOME
(SEE NET WAGES)
INCOME (Pg. 2)
WHERE INCOME WAS EARNED
*ALTERNATE CITY
*
ALTERNATE CITY LINE - see instructions
1
$
1. TOTAL NET TAX DUE ( TOTAL OF COLUMN G ) ..............................................................................................................................................
2. LESS CREDITS FOR ESTIMATED TAX PAYMENTS AND OVERPAYMENT FROM PRIOR YEAR RETURN ONLY ......
2
$
3
3. BALANCE DUE (LINE 1 LESS LINE 2). If Line 2 is greater than Line 1, enter amount (in brackets) here and carry to Line 6.
.......................
$
4. PENALTY: 10% $_____________ + INTEREST $_____________ =
........................................................................................................
4
$
(see instructions)
(see instructions)
5
$
5. TOTAL AMOUNT DUE (ADD LINES 3 AND 4). NOTE: NO PAYMENT IS DUE IF AMOUNT IS LESS THAN $1.00
6
$
6. OVERPAYMENT CLAIMED (IF LINE 2 EXCEEDS LINE 1)
......................................................................................
CARRY THIS AMOUNT TO LINE 8
6A $
A.
...
CREDITED
ENTER THE AMOUNT FROM LINE 6 YOU WANT
TO YOUR NEXT YEAR TAX ESTIMATE
B.
6B
ENTER THE AMOUNT FROM LINE 6 YOU WANT
REFUNDED
$
(MUST BE GREATER THAN $1.00)
Part C
2013 DECLARATION OF ESTIMATED TAXES
A declaration of estimated tax is required if all taxes are not fully withheld.
Column H
Column I
Column J
Column K
Column L
Column M
Column N
C
ESTIMATED INCOME FROM
ESTIMATED INCOME FROM
TOTAL
TAX
LESS TAX TO BE WITHHELD (W-2)
O
ESTIMATED
CITY
ESTIMATED
PAID BY A PARTNERSHIP OR
NET PROFITS, RENTS AND
D
WAGES, SALARIES,
NET ESTIMATED
RATE
NET TAX DUE
PAID DIRECTLY TO CITY WHERE
TAX DUE
OTHER TAXABLE INCOME
COMMISSIONS - ETC.
E
INCOME
INCOME WAS EARNED
*ALTERNATE CITY
7
$
7. TOTAL NET ESTIMATED TAX DUE (TOTAL OF COLUMN N)
.......................................................................................................................
8. OVERPAYMENT CREDITS FROM PREVIOUS YEAR RETURN (FROM LINE 6A)
...............................................
$
8
............................................................................................................
9. TOTAL CREDITS (AMOUNT FROM LINE 8)
9
$
10
10. UNPAID BALANCE DUE (SUBTRACT LINE 9 FROM LINE 7)
...............................................................................
$
............................................................................
11. LESS AMOUNT PAID WITH THIS DECLARATION (A minimum 25% of Line 7 due now)
11
$
12. ESTIMATED TAX BALANCE PAYABLE IN EQUAL INSTALLMENTS EACH QUARTER (Line 10 less Line 11) ........
12
$
13. TOTAL (ADD LINE 5 [if positive] AND LINE 11)
13
$
Third
Do you want to allow another person to discuss this matter with the City of Columbus?
(see instructions)
YES
NO
Complete the following
Party
Designee’s
Phone
(
)
Print Form
SSN
Designee
Name
No.
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for
SIGNATURE
MAILING INFORMATION
the taxable period stated, and that the figures used are the same as used for federal income tax purposes and
Reset Form
understands that this information may be released to the tax administration of the city of residence and the I.R.S.
NO Payment Enclosed:
Sign
Your
Mail to:
Columbus Income Tax Division
Here
Signature
Date
PO Box 182437
If a joint return,
Spouse’s
Columbus, Ohio 43218-2437
Date
both must sign.
Signature
Payment Enclosed:
Paid
SSN/EIN
Make payable to: CITY TREASURER
Preparer’s
Date
Signature
Mail to:
Columbus Income Tax Division
Use Only
Phone No.
(
)
PO Box 182158
Columbus, Ohio 43218-2158
Rev. 9/12/12
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