CITY OF WESTERVILLE
QUARTERLY INSTALLMENT OF ESTIMATED TAX – FORM Q-1                                                                                    RETURN 
INCOME TAX DEPARTMENT
64 E. WALNUT STREET, P.O. BOX 130
WESTERVILLE, OHIO 43086-0130                                                                                            THIS COPY
614-901-6420
Your Returned Check Will Be Your Receipt – DO NOT REMIT CASH BY MAIL
ESTIMATE DECLARED PREVIOUS YEARS CREDITS CURRENT YEAR CREDITS       CURRENT AMOUNT DUE                                        PAYMENT ENCLOSED

IF THIS STATEMENT DOES NOT REFLECT YOUR PAYMENTS AND CREDITS, PLEASE CONTACT US PROMPTLY                                      DUE ON OR BEFORE

                                                                                                                                     ACCOUNT #

                                                                    Who Must File: Any resident or business located in Westerville who expects to have a City of 
                                                                    Westerville Income Tax liability of greater than $2 00.00 at the close of the year must make an 
                                                                    estimate of tax liability and make and file payments toward such a liability.  The amount due is 
                                                                    exclusive of Westerville income tax withheld by an employer.  Penalty and interest shall apply for 
                                                                    failure to make the required estimated quarterly payments.

CITY OF WESTERVILLE
QUARTERLY INSTALLMENT OF ESTIMATED TAX – FORM Q-1                                                                       KEEP FOR 
INCOME TAX DEPARTMENT
64 E. WALNUT STREET, P.O. BOX 130
WESTERVILLE, OHIO 43086-0130                                                               YOUR RECORDS
614-901-6420
Your Returned Check Will Be Your Receipt – DO NOT REMIT CASH BY MAIL
ESTIMATE DECLARED PREVIOUS YEARS CREDITS CURRENT YEAR CREDITS       CURRENT AMOUNT DUE                                        PAYMENT ENCLOSED

IF THIS STATEMENT DOES NOT REFLECT YOUR PAYMENTS AND CREDITS, PLEASE CONTACT US PROMPTLY                                      DUE ON OR BEFORE

                                                                                                                                     ACCOUNT #

                                                                    Who Must File: Any resident or business located in Westerville who expects to have a City of 
                                                                    Westerville Income Tax liability of greater than $2 00.00 at the close of the year must make an 
                                                                    estimate of tax liability and make and file payments toward such a liability.  The amount due is 
                                                                    exclusive of Westerville income tax withheld by an employer.  Penalty and interest shall apply for 
                                                                    failure to make the required estimated quarterly payments.