Form WV-EZ                         CITY OF WESTERVILLE, OHIO                     
                            Division of Revenue – 64 East Walnut St. 
                                 Westerville, Ohio 43081 
 
Check your status as                     INCOME TAX RETURN WV -EZ          
a resident:                                                    DUE BY APRIL 15TH 
Full Yr. ( ) Part Yr. ( )                      FOR THE CALENDAR YEAR  __________ 
 
                                                                      Did you file a Westerville Return In ________?  YES (  ) NO (  ) 
                                                                               If Moved During Year Of This Return Give Date of Move  
                                                                                                                                                                                                                           
                                                                                                                                     INTO WESTERVILLE      OUT OF WESTERVILLE 
 
Name and Address - If incorrect please make necessary changes above 
______________________________________________________________________________________________________                                                                                                                    
 
                                     ATTENTION                                 
 
      ALL RESIDENTS OF THE CITY OF WESTERVILLE MUST FILE A TAX RETURN  
 
IF YOU HAVE TAXABLE INCOME YOU MUST FILE THE WESTERVILLE FORM R.   HOWEVER, IF YOU 
HAVE NO TAXABLE INCOME, COMPLETE THE FORM WV-EZ ( BELOW) AND RETURN THIS FORM WV-EZ 
 BY APRIL 15th, IN THE ENCLOSED ENVELOPE TO:   
 
                                 DIVISION OF TAXATION 
                                 64 EAST WALNUT STREET 
                                 WESTERVILLE, OHIO 43081 
 
FOR  QUESTIONS OR ASSISTANCE IN PREPARING YOUR RETURN, OR TO ACQUIRE A FORM R, CALL 901-6420 OR 
VISIT THE DIVISION OF TAXATION AT 64 EAST WALNUT STREET, WESTERVILLE, OH.  
 
PLEASE CHECK ANY OF THE FOLLOWING INCOME SOURCES YOU HAD: 
 
     _____  RETIREMENT PENSION                                        _____  SOCIAL SECURITY 
 
     _____  RENTAL INCOME/LOSS                                        ______  SELF-EMPLOYMENT                                                                             
      
     _____  PARTNERSHIP INCOME/LOSS                                   _____  JURY DUTY 
 
     _____  VOTING/PRECINT WORK                                       _____  CONSULTING 
 
     _____  PART -TIME  JOB 
 
                                                                                                                                I CERTIFY ALL INFORMATION TO BE TRUE: 
                                                                                                                                                                                                                           
                                                                                 ______________________________________  
                                                                                                                                                   SIGNATURE                                                      (DATE) 
                                                                                                                                                                                                                           
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                                                                                                                                                   SOCIAL SECURITY # 
                                                                                                                                                                                                                           
                                                                                 _______________________________________________  
                                                                                                                                                    SPOUSE,  IF JOINT RETURN                          (DATE)           
     
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                                                                                                                                                    SOCIAL SECURITY #    
White Copy To Westerville/ Canary Copy is Your Copy