City of Akron                                                            Telephone:  330-375.2290
          Income Tax Division                                                      Email:  incometax@akronohio.gov
          1 Cascade Plaza - Suite 100
          Akron, OH  44308-1161
                  Tax Form Completion Request Form / Declaration of Exemption Form
                            General Information (All Taxpayers  Must Complete This Section)
Name:
Current Street Address or PO Box Number:
City, State, ZIP
Tax Year:                   Phone # and Best Time to Call: 
Social Security #                                   Spouse Social Security # (if filing Joint):

If you have moved since January 1 of the Tax Year above:
Previous Street Address or PO Box #:
City, State, ZIP
Date moved from this address:

                  Declaration of Exemption  (Complete This Section only if         Claiming Exemption)
I Declare that I am Exempt from Filing an Annual Income Tax Return for the Following Reason:
I am under 18 years old.             Date of birth:          Include copy of birth certificate or driver's license.
____________________________ is/are retired and receiving only non-taxable income. Date(s) retired:
I was a member of the U.S. Armed Forces for the entire year (not a civilian employee ) with no taxable Income.
I have no Akron Taxable Income to report this year         Explain:

Under penalties of perjury, the undersigned declare that the information supplied above is true, correct, and complete, and that if
either/both taxpayers begin to earn income taxable by the City of Akron this exemption statement will become void.

Signature(s):                                                               Date: 

                        Tax Form Completion Request (Do Not Complete  ifClaiming Exemption)
I Request the City of Akron to Complete my Annual Income Tax Return for Me and Provide the Following Documents:
W-2s      (Include copy to be filed with Employee City or Local Tax Return)
W-2Gs           (Include copy to be filed with Employee City or Local Tax Return)
Schedule C - Profit or Loss from Business *
Schedule E - Supplemental Income and Loss (including Income from Rental properties)*
Form 1099-NEC/MISC *
* Please include the first two (2) pages of Federal Form 1040 and Schedule 1

May a City of Akron Income Tax Department representative call you if we have a question?                        Yes                  No
Under penalties of perjury, the undersigned declares that the accompanying documentation (if any) is true, correct and complete for
the the taxable period and that the figures are the same as those used for federal income tax purposes.  By completing this form and
submitting the necessary information and documentation, the undersigned requests the City of Akron to complete their municipal
income tax return, and understands that it is the responsibility of the taxpayer to pay any tax due by the deadline for such payment.

Signature(s):                                                               Date: 

If applicable, a copy of your completed income tax return will be sent to you.  If the return reflects a balance due, you will
be billed by the City of Akron.  Penalty and interest may be added.   Payment should be made to:  CITY OF AKRON.