THE CITY OF SPRINGFIELD
INCOME TAX DIVISION OFFICE HOURS
STATE OF OHIO
CITY HALL 8 AM to 5 PM
PO Box 5200 Monday through Friday
76 E High Street
Phone 937/324-7357
Springfield, OH 45501
Fax 937/328-3471
www.springfieldohio.gov taxfilinghelp@springfieldohio.gov
INDIVIDUAL or JOINT INCOME TAX QUESTIONNAIRE
Springfield has a mandatory filing requirement for all residents 18 years of age and older.
If married, do you plan on filing Springfield Income Tax Return: ____Individually (Taxpayer 1) or ____Jointly (Taxpayer 2)
- - PLEASE PRINT LEGIBLY. - -
TAXPAYER 1: (Office Use Only: ACCOUNT # ___________________) TAXPAYER 2 (Office Use Only: ACCOUNT # _____________________)
NAME NAME
SSN: DOB: SSN: DOB:
Phone #: ___ Home ___Cell ___ Work Phone #: ___ Home ___Cell ___ Work
EMAIL Address EMAIL Address
CURRENT ADDRESS: CURRENT ADDRESS:
CITY, STATE, ZIP: Date In CITY, STATE, ZIP: Date In
FORMER ADDRESS: FORMER ADDRESS:
CITY, STATE, ZIP: In_____ Out CITY, STATE, ZIP: In_____ Out
FORMER ADDRESS: FORMER ADDRESS:
CITY, STATE, ZIP: In_____ Out CITY, STATE, ZIP: In_____ Out
EMPLOYER Name: EMPLOYER Name:
Address: Address:
Date Employment Began _______ Date Employment Ended_________ Date Employment Began _______ Date Employment Ended_________
Employer withholds Tax for what City: Employer withholds Tax for what City:
EMPLOYER Name: EMPLOYER Name:
Address: Address:
Date Employment Began _______ Date Employment Ended_________ Date Employment Began _______ Date Employment Ended_________
Employer withholds Tax for what City: Employer withholds Tax for what City:
SELF-EMPLOYED: If Yes, Type of Business SELF-EMPLOYED: If Yes: Type of Business
Business Name Business Name
Business Address Business Address
If you have Employees, your Federal ID # If you have Employees, your Federal ID #
RENTAL PROPERTY: (Use back of form if you own more than 1 property.) RENTAL PROPERTY: (Use back of form if you own more than 1 property.)
Who owns the Property? _ Who owns the Property? _
Property Location (Actual) Address Property Location (Actual) Address
OTHER INCOME: (partnership, commissions, fees, etc.) List Below: OTHER INCOME: (partnership, commissions, fees, etc.) List Below:
If you are not liable for Springfield City tax, give reason: If you are not liable for Springfield City tax, give reason:
(Active Duty Military income and some types of Retirement income are not taxable; (Active Duty Military income and some types of Retirement income are not taxable;
however, you are still required to file a Springfield Tax Return.) however, you are still required to file a Springfield Tax Return.)
NAMES, SOCIAL SECURITY NUMBERS, and BIRTHDAYS of other members in the household over age 18:
Name: _______________________________________________________ SSN: _______/_______/______ DOB: _____________ _____________
Name: _______________________________________________________ SSN: _______/_______/______ DOB:
Name: _______________________________________________________ SSN: _______/_______/______ DOB: ____________________________
SIGNED __________________________________Date ________________ SIGNED __________________________________Date
REV 08.2021