Please change tax                   Print Form
FORM Q1 1107                                                          RETURN  WITH  PAYMENT   year if necessary Select Quarter Being Paid
                                                                      QUARTERLY ESTIMATE      u 2015

MAKE CHECK OR MONEY ORDER TO:                                         Warren City Income Tax                    AMOUNT
       WARREN CITY INCOME TAX                                    MAIL P.O. BOX 230
                                                                 TO   WARREN  OH   44482-0230                   ENCLOSED $
PAID CHECK WILL BE YOUR RECEIPT
If receipt is desired, return both copies of this statement with                                                Check No:
a self-addressed stamped envelope.
                                                                      Voice  330-841-2551     Fax  330-841-2626
   DO NOT REMIT CASH BY MAIL
ESTIMATED TAX                     TOTAL UNDER PAID                    TOTAL AMOUNT CREDITED   AMOUNT OF                  QUARTERLY
   DECLARED                       ESTIMATE PENALTY                                            UNPAID BALANCE          INSTALLMENT DUE

Name                                                                                          AMENDED ESTIMATED TAX   DUE ON OR BEFORE

And

Address
                                                                                                                TAX ID

                                                                                                                FID#/SSN