| | 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 |