FORM P/I
               CITY OF BROOK PARK INCOME TAX
       PENALTY AND INTEREST ASSESSMENT
ACCOUNT NUMBER      DUE ON OR BEFORE     YEAR                                          PERIOD
                                                                                             OFFICE USE       AMOUNT DUE
FILE TAX RETURNS AND PAY TAXES PROMPTLY TO AVOID PENALTIES
                                                                                             FOR THE LATE PAYMENT OF EMPLOYEE
                                                                                             WITHHELD TAXES.
                                                                                             FOR THE LATE FILING OF THE CITY TAX
                                                                                             RETURN.           SECOND NOTICE
                                                                                             FOR THE REFUSAL TO FILE A DECLARATION
                                                                                             AND PAY ESTIMATED TAXES AS REQUIRED.
                                                                                             FOR THE UNDERPAYMENT OF ESTIMATED
NOTIFY DEPARTMENT OF TAXATION PROMPTLY OF ANY CHANGES IN OWNERSHIP OR NAME AND ADDRESS       TAXES AS REQUIRED
MAKE CHECK OR MONEY      MAIL TO: DEPARTMENT OF TAXATION                                     FOR THE LATE FILING AND PAYMENT OF CITY
ORDER PAYABLE TO         6161 ENGLE ROAD                                                     INCOME TAXES.
CITY OF BROOK PARK, OHIO BROOK PARK, OHIO 44142