File with Fairfield Income Tax
701 Wessel Drive
Fairfield OH 45014-3611
(513) 867-5327
Fax (513) 867-5333
Forms available at
www.fairfield-city.org
PROVIDE NAME & ADDRESS OR CHANGES BELOW
Your social security number
Spouse’s social security number
Resident Date moved in
Non Resident Date moved out
Sole Proprietor
City of Employment
Phone #
FILING Single
STATUS Married filing joint return (even if only one had income). Did you file joint or separate last year?
Joint Separate
Married filing separate return. Enter spouse’s social security number above and full name here:
INCOME 1. Total W-2 wages. W-2s MUST BE ATTACHED .................................................................................. 1 $
2. Other Taxable Income or Deductions from Line 23* from side two (back) of this form ............ 2 $
3. Total Taxable Income ................................................................................................................ 3 $
TAX 4. Fairfield Tax is 1.5% (.015) of Line 3 ........................................................................................ 4 $
TAX WITHHELD, 5. Tax Credits: Credit will only be given with proper documentation.
PAYMENTS A. Fairfield income tax withheld............................................................5A $
AND B. Income tax withheld/paid to other cities (1.5% maximum) .......... 5B $
CREDITS C. Prior year overpayments ................................................................ 5C $
D. Estimated payments........................................................................ 5D $
E. Total tax credits (Lines 5A through 5D) ............................................................................ 5E $
BALANCE DUE 6. Balance Due, if Line 4 is greater than Line 5E. Subtract Line 5E from Line 4 ........................ 6 $
7. Overpayment, if Line 4 is less than Line 5E. Subtract Line 4 from 5E .................................. 7 $
A. REFUND amount ............................................................................ 7A $
B. CREDIT amount.............................................................................. 7B $
(Amounts less than $1.00 are not paid, refunded, or credited).
ESTIMATE 8. Total income subject to tax $ multiply by tax rate of 1.5% (.015) ................ 8 $
FOR NEXT 9. Estimated income tax to be withheld or paid to other cities .................................................. 9 $
YEAR 10. Estimated tax due (Line 8 minus Line 9).
If less than $200, estimated payments are not required
10 $
11. First quarter estimated tax payment (minimum of 22.5% (.225) of Line 10) .......................... 11 $
12. Prior year tax credit from Line 7B above.................................................................................. 12 $
13. If Line 12 is greater than Line 11, enter 0, otherwise enter amount of Line 11 less Line 12 13 $
TAX DUE 14. TOTAL TAX DUE (Lines 6 and 13) .......................................................................................... 14 $
PAYMENT BY CREDIT CARD (Check One)
i[r No.
PAYMENT BY CHECK: Payable to Fairfield Income Tax Exp. Date:
The undersigned declares that this return (and accompanying schedules) is true, correct and complete for the taxable period stated and that
the figures used herein are the same as used for Federal Income Tax purposes.
May we discuss return with your tax practitioner? (Check One) Yes No
SIGNATURE OF TAXPAYER DATE
SIGNATURE OF TAXPAYER DATE
SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER DATE
NAME AND ADDRESS OF PREPARER TELEPHONE NUMBER
SIGNATURE(S) REQUIRED
DECLARATION OF ESTIMATED TAX FOR 2009 (See Instructions for requirements)
FOR TAX DIVISION USE ONLY
Date
Tax Bal
Interest
Penalty
Total
FORM IR
CITY OF FAIRFIELD
INDIVIDUAL INCOME TAX RETURN 2008
OR
FISCAL PERIOD TO
CALENDAR YEAR TAXPAYERS FILE ON OR BEFORE APRIL 15TH
AND FISCAL YEAR TAXPAYERS FILE BY THE 15TH DAY OF THE
FOURTH MONTH AFTER THE CLOSE OF THE PERIOD.
IF TAXPAYER AND SPOUSE ARE FULLY RETIRED AND WITHOUT TAXABLE INCOME, PLACE AN X IN THE BOX, COMPLETE SIGNATURE SECTION BELOW.
ATTACH W-2’S HERE
IF TAXPAYER AND SPOUSE ARE FULLY RETIRED AND WITHOUT TAXABLE INCOME, PLACE AN X IN THE BOX, COMPLETE SIGNATURE SECTION BELOW.
DECLARATION OF ESTIMATED TAX FOR 2013 (See Instructions for requirements)
SIGNATURE(S) REQUIRED
2012