TO BE FILED WITH:              20_ _ INDIVIDUAL DECLARATION OF 
READING TAX OFFICE                                                                               OFFICE HOURS: 
1000 MARKET STREET                       ESTIMATED TAX 
                                         ST                                   ND    7:00 AM TO 5:00 PM 
 READING, OH 45215                      1  (APRIL 15) 2  (JULY 31)                  MONDAY - FRIDAY 
                                     RD                                       TH
Phone # (513) 733-0300               3  (OCTOBER 31) 4  (JANUARY 31) 
 Fax # (513) 842-1016 

TAXPAYER NAME AND ADDRESS                                                        ACCOUNT # ____________________________ 
                                                                                                      (SSN / FEDERAL ID #) 
 
                                                                                 DATE MOVED INTO READING____/____/____ 
                                                                                                                                                                                                                      
ESTIMATE SHOULD BE BASED ON NUMBER OF MONTHS LIVED IN READING 
                                                                                                     
1. TOTAL INCOME SUBJECT TO TAX $__________ MULTIPLY BY 2.0% FOR                                     $ ____________ 
    GROSS TAX 
2. LESS EXPECTED TAX CREDITS NOT TO EXCEED 2.0% OF THAT PORTION                                      
    TAXED 
                   a. WITHHELD BY EMPLOYER FOR READING                             $ ____________    
                                                                                                     
                   b. PAYMENTS TO ANOTHER MUNICIPALITY                             $ ____________ 
                                                                                    
                   c. TOTAL CREDITS                                                                 $ ____________ 

3. NET ESTIMATED TAX DUE FOR 20_ _ (LINE 1 MINUS 2C)                                                $ ____________ 
4. AMOUNT DUE WITH THIS DECLARATION (NOT LESS THAN ___ OF LINE 3)                                   $ _____________ 
                a. LESS OVERPAYMENT FROM PRIOR YEAR                                $ ______________  
5. TOTAL OF ___ QUARTER 20_ _ DUE                                                                   $ ____________ 
 
I CERTIFY THAT I HAVE EXAMINED THIS DECLARATION AND TO THE BEST OF MY KNOWLEDGE AND BELIEVE IT IS TRUE, CORRECT, AND 
COMPLETE.  IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH 
PREPARER HAS ANY KNOWLEDGE. 
 
__________________________________________________                            ________________________________________________ 
SIGNATURE OF PREPARER (OTHER THAN TAXPAYER)                                   SIGNATURE OF TAXPAYER                                        DATE 
 
__________________________________________________                                
ADDRESS                                                           TELEPHONE # 
 
                                     CREDIT CARD AUTHORIZATION: 

□ VISA              □ MASTERCARD 
 
Print Name:         ________________________________________ 
 
Signature:          ________________________________________ 
 
Account Number 

□□□□ □□□□ □□□□ □□□□                                                                
Expiration Date: ______ / ______                     CVC______ 3 digit security code on back of card