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 $ 00.00 at the close of the year must make an2  
                                                                     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 $ 00.00 at the close of the year must make an2  
                                                                     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.