CITY OF BROOK PARK — DEPARTMENT OF TAXATION
STATEMENT OF ESTIMATED TAX DUE 6161 ENGLE RD. BROOK PARK, OH 44142 216-433-1533
Cash, check, MasterCard, VISA or pay on-line TAX CONNECT are acceptable payment methods. For ACH-Debit or
credit card internet payments visit www.cityofbrookpark.com and click on the TAX CONNECT link.
If you have moved out of Brook Park, please
complete the “Move Out Date” and “New
Address” section. The original declaration,
shown in BOX 1, will require an amendment.
Individuals with W-2 income only, may submit
pay-stubs closest to the move out date, for
departmental recalculation. Business income
taxpayers (rentals, self-employment,
corporations, etc) submit revised figures in the
“Amend Here” box.
IMPORTANT INFORMATION FOR ESTIMATED TAXPAYERS
YEAR ACCOUNT NUMBER
The City of Brook Park requires all taxpayers who expect to owe more than $200.00 in tax for the current
filing year to make quarterly estimated tax payments.
1 ORIGINAL
Estimates for the current year are billed quarterly, with the exception of the first quarter, which is due to DECLARATION
AMOUNT $
be paid with your tax return by April 15. The remaining three quarters are due by June 15, September 15, 2 PRIOR YEAR
and December 15 (businesses) or January 15 (individuals) respectively. If you wish to pay your full CREDIT $
estimate at once, you may do so. (FISCAL YEAR TAXPAYERS WILL SUBSTITUTE THEIR 3 PAYMENTS
CORRESPONDING DATES) TO DATE $
To avoid penalty and interest, you must pay 100% of your prior year’s tax or 90% of your current year’s 4 UNPAID
actual tax liability by the last quarterly due date. BALANCE $
If your circumstances change, you may amend your estimated taxes for the current year. Please fill the 5 AMOUNT
NOW DUE
amended box below, attach pay stubs or other documents, and return form to the Tax Department. $
6 AMOUNT
* The City of Brook Park is offering a new on-line payment process called ACH-Debit. This method PAID
HEREWITH $
provides 24/7 availability without any convenience fees attached. To register, please complete the
information requested on the back of this statement and return it along with a voided check. Once
banking information is in our system, payments can be made via Tax Connect by choosing the ACH-Debit
method.
CHECKS PAYABLE TO CITY OF BROOK
RETAIN THIS PORTION ABOVE PERFORATION FOR YOUR RECORDS PARK DEPARTMENT OF TAXATION
BQ1 AMEND HERE RETURN ONLY THIS PART BELOW PERFORATION
USE THIS BOX ONLY FOR ADJUSTING YOUR ORIGINAL DECLARATION If you have moved out of Brook Park, please
complete the “Move Out Date” and “New Address”
AMENDED ESTIMATED INCOME section. The original declaration, shown in BOX 1,
AMENDED DUE OTHER CITY will require an amendment. Individuals with W-2 YEAR ACCOUNT NUMBER
income only, may submit pay-stubs closest to the
AMENDED ESTIMATED TAX DUE move out date, for departmental recalculation.
Business income taxpayers (rentals,
ACCOUNT NUMBER DUE ON OR BEFORE self-employment, corporations, etc) submit revised 1 ORIGINAL
figures in the “Amend Here” box. DECLARATION
AMOUNT $
MOVE OUT DATE: _________ /________ ________/ 2 PRIOR YEAR
NEW ADDRESS: _____________________________ CREDIT $
____________________________________________ 3 PAYMENTS
____________________________________________ TO DATE $
4 UNPAID
PAY-STUBS ENCLOSED BALANCE $
5 AMOUNT
NOW DUE $
6 AMOUNT
PAID
HEREWITH $
SIGNATURE DATE RETURN THIS PART
I certify I have reviewed this form and understand the laws governing estimated tax. 000001