No Income 
                    Individual City Income Tax Return 

                        Tax Year 20 __                                                      
                        Return Due on or Before April 15th 
 FORM IR-NO                                                                                                                                         DATE RECEIVED 
          Per the Englewood Tax Ordinance, all residents are required to file an income tax return  
          even if there is no taxable income and regardless of whether Federal or State returns are filed. 

__________________________________________________   ______________   ____________________________ 
Taxpayer Name                                                                             Date Of Birth   (mm/dd/yyyy)       Social Security Number 
 
__________________________________________________   ______________   ____________________________ 
Spouse Name                                                                               Date Of Birth (mm/dd/yyyy          Social Security Number 
 
____________________________________________________________   __________________________________ 
Address                                                                                                      Email 
 
_______________________________________________  ________  ____________   _________________________ 
City                                                                                State            Zip                Phone Number 

 Check Reason for Filing as No Income:                                       Retired      Disabled                    Unemployed               Active Military 

 1. DID YOU HAVE W-2 INCOME? ……………………………………………………………………..  YES                                                                                      NO 
    (PENSION AND SOCIAL SECURITY INCOME IS NOT W-2 INCOME)                                                                                           
                                                                                                                                                     
 2. DID YOU OWN RENTAL PROPERTY? …………………………………………………………….  YES                                                                                      NO 
                                                                                                                                                     
 3. DID YOU PARTICIPATE IN A BUSINESS, PARTNERSHIP OR PASS THRU ENTITY? …….  YES                                                                    NO 
                                                                                                                                                     
 4. DID YOU HAVE GAMBLING WINNINGS (W-2G)? ………………………………………………..  YES                                                                                NO 

                If your answer is YES to any of the questions above, you must file the  
          Individual City Income Tax Return which can be found on our website www.englewood.oh.us.  
     The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return  
     for the taxable period stated and that the figures used herein are the same as used for Federal income tax  
     purposes, adjusted to the ordinance requirements for local tax purposes, and if an audit of the Federal return is  
     made which affects the tax liability shown on the return an amended return is required to be filed within three months.   

______________________________________________________________                                                        ______________________________ 
SIGNATURE OF TAXPAYER                                                                                                               DATE 
                                                                                                                                               
______________________________________________________________                                                        ______________________________ 
SIGNATURE OF SPOUSE                                                                                                                 DATE 
                                                                                                                                               
______________________________________________________________ 
TAX PREPARER SIGNATURE 
                                                                           May Our Office Discuss this  
                                                                                                                                    CONTACT  INFORMATION 
_________________________________                                          Return with the Preparer? 
                                                                                                                                    City of Englewood 
TAX PREPARER EMAIL                                                           YES      NO                                            Income Tax Department 
                                                                                                                                    333 W National Rd 
                                                                                                                                    Englewood, OH  45322 
 
Office Use Only:            Account # _______________                                                                               937-836-5106 
                                                                                                                                    tax@englewood.oh.us