Exemption Form Sidney (Page 2 of 2) in pdf

CITY OF SIDNEY

DECLARATION OF EXEMPTION FORM

INSTRUCTIONS

If you were a wage‐earner, were self‐employed, owned rental property, or derived any other city taxable income you are NOT

exempt from the annual filing requirement and may not use this form.

______________________________________________________________________________________________________

EXEMPTION #1

If you were retired for the entire year in question, receiving only income not taxable by the City of Sidney

(pension income, social security, interest, dividends, capital gains or other non‐taxable income) for all of

the year AND do not anticipate deriving any Sidney taxable income in the future, indicate so by filling in

the date of your retirement. Permanently retired individuals need file this form only once. However, if

your status changes and you again become employed or earn Sidney taxable income, you will be required

to file a Sidney tax return for any full/partial year in which such income is earned.

______________________________________________________________________________________________________

EXEMPTION #2

If you were permanently disabled for the entire year in question, receiving only social security, interest,

dividends, capital gains or other non‐taxable income for all of the year AND do not anticipate deriving any

Sidney taxable income in the future, indicate so by filling in the date of your permanent disability. Attach

documentation supporting your permanent disability. Permanently disabled individuals need file this

form only once. However, if your status changes and you again earn Sidney taxable income, you will be

required to file a Sidney tax return for any full/partial year in which such income is earned.

______________________________________________________________________________________________________

EXEMPTION #3

If you are not retired or permanently disabled, but did not receive any Sidney taxable income for the year

in question, indicate so by checking Box 3 and attaching page 1 of your Federal Form 1040. This

exemption is for one year only and this form must be completed for each subsequent applicable year.

Non‐taxable income includes interest, dividends, capital gains, military pay, income earned while under

the age of 16, alimony, social security benefits, welfare payments, unemployment benefits, workers’

compensation benefits, and pension income.

______________________________________________________________________________________________________

EXEMPTION #4

If you did not reside in the City of Sidney at all during the year in question, indicate so by filling in the date

you moved into or out of Sidney. College students with a legal residence in Sidney are not exempt from

filing. A majority of students are living at their respective colleges during the school year; however, their

domicile (legal residence) is their parents’ home.

______________________________________________________________________________________________________

EXEMPTION #5

If the taxpayer in question is deceased, the executor of the taxpayer’s estate should indicate the

taxpayer’s date of death.

______________________________________________________________________________________________________

EXEMPTION #6

If you were on active duty in the U.S. Armed Forces for the entire year in question and received no

income taxable by the City of Sidney, indicate so by checking Box 6. Military pay and allowances of

members of the U.S. Armed Forces, including reserve components and the Ohio National Guard are not

taxable. This exemption is for one year only and this form must be completed for each subsequent

applicable year. Attach documentation supporting your military status.

______________________________________________________________________________________________________

EXEMPTION #7

If you have filed jointly with your spouse, indicate so by filling in the name of the spouse and provide the

Social Security Number at the top of the form. If, in a subsequent year, a married couple elects to file

separately, it shall be the responsibility of each spouse to obtain and file a return.

______________________________________________________________________________________________________

In all cases where you are eligible for exemption, you must provide your social security number, name, address and phone

number. THIS EXEMPTION FORM IS NOT VALID AND WILL NOT BE PROCESSED WITHOUT THE TAXPAYER’S SIGNATURE.

Answers to frequently asked questions and an expanded list of taxable and non‐taxable income can be found at our website ‐

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If you have questions or need assistance completing this form, please contact our office. We can be reached by email at

, by phone at (937) 498‐8111, or by fax at (937) 498‐8149.

Exemption Form Sidney Page 2

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