2015 SOUTH LEBANON INCOME TAX RETURN 2015
Form IR
Filed With
MAKE CHECK OR
SOUTH LEBANON TAX DEPT.
FIILING REQUIRED EVEN IF NO TAX IS DUE
MONEY ORDER PAYABLE TO:
99 N. HIGH ST.
ON OR BEFORE APRIL 18, 2016
SOUTH LEBANON TAX DEPT.
P.O. BOX 40
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
P
SOUTH LEBANON, OH 45065
HONE: (513) 494-2296
OFFICE HOURS 8:00 A.M. to 4:30 P.M.
FAX: (513) 299-0552
Social Security Number ______-_______-_______ Spouse’s Social Security Number ______-_______-_______
Name and Address:
TO PAY BY CREDIT CARD: Enter number and expiration date fully
and accurately:
16 Digit Card No: __-__-__-__-__-__-__-__-__-__-__-__-__-__-__-__
Exp Date (mm/yy): ___-___ \ ___-___ Security Code: ____-____-____
Amount Authorized $________________________________
If moved since the previous return was filed give date:
Phone number: _____________________________________
Move INTO South Lebanon__________. Moved OUT of South Lebanon__________.
Card Holders Signature: ______________________________
PART A. I/WE ARE NOT REQUIRED TO COMPLETE PART B OF THIS RETURN
DUE TO THE FOLLOWING REASON (PLEASE CHECK) SIGNATURE(S) REQUIRED AT BOTTOM OF FORM.
SUPPORTING DOCUMENTATION MUST BE ATTACHED. FORM WILL BE RETURNED IF NOT ATTACHED!!
____ TOTAL/PERMANENT DISABILITY
____ MOVED OUT PRIOR TO 2015; LIST MOVE DATE: ________________
LIST NEW ADDRESS: ___________________________________________
____ RETIREMENT INCOME ONLY
____ DECEASED: DATE OF DEATH: _____________________________
____ FULL TIME STUDENT (transcripts showing
____ ONLY INCOME IS FROM NON-TAXABLE SOURCE; LIST
credit hours must be included)
SOURCE: _____________________________________________________
PART B.
FORMS RECEIVED WITHOUT COMPLETE DOCUMENTATION WILL BE RETURNED.
OFFICE USE ONLY
1. TOTAL QUALIFYING WAGES (TYPICALLY BOX 5 ON W-2) (ATTACH W-2’S AND PAGE 1 OF FEDERAL 1040)
$_____________________
$ _ _ _ _ _ _ _ _ _ _
2. OTHER TAXABLE INCOME OR DEDUCTIONS FROM SIDE 2 – SEE INSTRUCTIONS ……………………………… $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
3. TAXABLE INCOME: (LINE 1 PLUS OR MINUS LINE 2) ……………………………………………………………………. $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
4. SOUTH LEBANON TAX – 1% OF LINE 3 ………………………………………………………………………………….… $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
5. CREDITS:
A. TAX WITHHELD BY EMPLOYER FOR VILLAGE OF SOUTH LEBANON …. $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
B. 2015 ESTIMATED TAX PAID TO VILLAGE OF SOUTH LEBANON ………
$ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
C. PRIOR YEAR TAX OVERPAYMENT (Carried forward from 2014)…………… $ _____________________
$ _ _ _ _ _ _ _ _ __
D. 2015 TAX PAID TO ANOTHER MUNICIPALITY……………………..
$ _____________________
$ _ _ _ _ _ _ _ _ _ _
NOT TO EXCEED ½% OF THAT PORTION TAXED PER W-2.
ATTACH APPROPRIATE DOCUMENTATION. LIMITED TO ½ OF THE TAX ON LINE 4.
E. TOTAL CREDITS (ADD 5A – 5D)……………………………………………………………………………………$(______________________)
$(_ _ _ _ _ _ _ _ _ _ _)
6. IF LINE 4 IS GREATER THAN LINE 5E PAYMENT OF BALANCE MUST ACCOMPANY THIS RETURN –TAX DUE: $ ____________________
$ _ _ _ _ _ _ _ _ _ _ _
A.
LATE FILING PENALTY $ 25.00, INTEREST $ ___________.....................................……..TOTAL $ ___________________
$
TOTAL AMOUNT DUE FOR 2015………………………………………………………………. …………………………...……………
B.
7. OVERPAYMENT TO BE REFUNDED $ _______________ OR CREDITED $ _______________ TO NEXT YEARS ESTIMATED
*NO TAXES DUE OR REFUNDS OF LESS THAN $1.00 SHALL BE COLLECTED OR REFUNDED*
2016 DECLARATION OF ESTIMATED TAX FOR YEAR 2016
8. TOTAL INCOME SUBJECT TO TAX $ ________________________ MULTIPLY BY TAX RATE 1% FOR GROSS TAX OF ………………$ _______________________
9. LESS EXPECTED TAX CREDITS:
TAX WITHHELD BY EMPLOYER FOR VILLAGE OF SOUTH LEBANON …………………………… $ ____________________
A.
PAYMENTS ON TAXABLE INCOME TO ANOTHER MUNICIPALITY (NOT TO EXCEED 1/2%)…. $____________________
B.
OVERPAYMENT FROM PRIOR YEAR ………………………………………………………………….. $ ____________________
C.
D.
TOTAL CREDITS (ADD LINES A -C)…..………….………………………………………...…………….. $ ____________________
10. NET TAX DUE (LINE 8 MINUS LINE 9D) …………………………………………………………………………………………………………………… $ ___________________
11. AMOUNT PAID WITH THIS DECLARATION (NOT LESS THAN ¼ OF LINE 10) …………………………………1
ST
QTR. 2016 TAX DUE $ _______________________
$
12. 2015 TAX DUE (LINE 6B) $ ___________________, PLUS 2016 DECLARATION (LINE 11) $ _____________________ = TOTAL DUE
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE,
CORRECT AND COMPLETE. IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH THE PREPARER HAS ANY
.
KNOWLEDGE
__________________________________________
____________________________________________
SIGNATURE OF PERSON PREPARING OTHER THAN TAXPAYER
DATE
SIGNATURE OF TAXPAYER OR AGENT (REQUIRED TO BE VALID)
DATE
__________________________________________
PREPARER’S ADDRESS
TELEPHONE NO.
__________________________________________
___________________________________________
PREPARER’S FID OR SSN
SIGNATURE OF SPOUSE
DATE
Check here if we may contact the above preparer with questions.