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CITY OF MANSFIELD INCOME TAX RETURN INCOME TAX DIVISION YEAR 2023 INDIVIDUAL P.O. BOX 577 Pay by phone 419-755-9711 option 2 MANSFIELD, OHIO 44901 FILE BY APRIL 15, 2024 TELEPHONE (419) 755-9711 ATTACH FEDERAL EXTENSION IF Pay online: www.ci.mansfield.oh.us Drop off box: 1 stfloor and Court FAX (419) 755-9751 FILED AFTER APRIL 15TH Entrance Name ____________________________ Primary Soc Sec # _____ - _____- _____Birthdate _____/_____/_____ Name ___________________________________ Spouse Soc Sec # ______ - ______ - ______ Birthdate _____/_____/_____ Address ____________________________ City _________________________ State __________ Zip ___________ PARTIAL YEAR RESIDENT: DATE MOVED INTO MANSFIELD ____/_____/_____ DATE MOVED OUT OF MANSFIELD _____/_____/_____ DID YOU FILE A CITY RETURN LAST YEAR? Yes _____ No _____ SHOULD YOUR ACCOUNT BE INACTIVATED? Yes _____ No _____ If Yes explain __________________________________________ FILING STATUS: NON-FILING STATUS: NO TAXABLE INCOME _________ ______ INDIVIDUAL/MARRIED FILING SEPARATELY UNDER 18 – ATTACH PROOF OF BIRTHDATE ______ JOINT –BOTH SIGNATURES REQUIRED RETIRED-DATE ______/_______/________ CALCULATE 1. TOTAL W-2 WAGES (FROM WORKSHEET A) (Important: Attach all W-2’s & W-2Gs and 1040, 1040A or 1040EZ) ……. $__________ TAXABLE INCOME 2. OTHER INCOME (FROM WORKSHEET B) …………………………………………………………………………………………………………………………. $__________ 3. TOTAL INCOME (ADD LINES 1 AND 2) ……………………………………………………………………………………………………………………………. $__________ 4. ADJUSTEMENT (FROM WORKSHEET C) ……………………………………………………………………………………………………………………………. $__________ 5. SUBTRACT LINE 4 FROM LINE 3 …………………………….……………………………………………………………………………………………………… $__________ 6. PRIOR YEAR(S) CARRYOVER LOSS (SEE INSTRUCTIONS).……………………………………………………………………………………………. $__________ 7. MANSFIELD TAXABLE INCOME (SUBTRACT LINE 6 FROM LINE 5) …………………………………………………………………………………… $__________ 8. MANSFIELD INCOME TAX (MULTIPLY LINE 7 BY .02) …………………………………………………………………… $__________ ___________ CALCULATE 9. CREDITS: A. MANSFIELD INCOME TAX WITHHELD BY EMPLOYERS……………………………………………… $___________ TOTAL TAX CREDITS B. ESTIMATED TAX PAYMENTS AND/OR PRIOR YEAR CREDITS…………………………………… $___________ C. RESIDENTS ONLY INCOME TAXES PAID TO OTHER CITIES (SEE INSTRUCTIONS–Limit 1%) $___________ D. TOTAL CREDITS (ADD LINES 9A THROUGH 9C) ……………………………………………………… $___________ 10. TAX DUE (SUBTRACT LINE 9D FROM LINE 8) If $10.00 or less enter zero………………………………….. $___________ 11. LATE FILING FEE (SEE INSTRUCTIONS) ……………………………………………………………………………………….. $___________ 12. LATE PAYMENT PENALTY (SEE INSTRUCTIONS TO CALCULATE) IF PAID AFTER DUE DATE ……... $___________ 13. INTEREST (PLEASE SEE INSTRUCTIONS TO CALCULATE) IF PAID AFTER DUE DATE ………………. $___________ 14. TOTAL DUE (ADD LINES 10, 11, 12 and 13)…………………………………………………………………………………. $____________ ____________ OVERPAYMENT 15. OVERPAYMENT CLAIMED: TO BE REFUNDED $ ___________ CREDITED TO NEXT YEAR $____________ DECLARATION OF ESTIMATED MANSFIELD, OHIO CITY INCOME TAX FOR 2024 16. Total income subject to tax $ _________________ multiply by 2.00% (2024 tax rate) ………………………………………………………………………… $ ___________ 17. Estimated credits (tax withheld, paid by partnerships, paid to other cities, line 15 prior year credit) ……………………………………………………… $ ___________ 18. Net Tax Due (line 16 less Line 17) ………………………………………………………………………………………………………………………………………………………………… $ ___________ 19. First installment of declaration (Multiply line 18 by at least 22.5%) …………………………………………………………………………………………………………… $ ___________ 20. Less overpayment from line 15 above: ($...............................) = Balance due with return ….…………………………………………………………… $ ___________ 21. TOTAL AMOUNT DUE (ADD Lines 14 and 20) ………………………………………………………………………. PAY THIS AMOUNT $ _________ IF THIS RETURN WAS PREPARED BY A TAX PRACTITIONER, CHECK HERE IF WE MAY CONTACT HIM/HER DIRECTLY WITH QUESTIONS REGARDING THE PREPARATION OF THIS RETURN. The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and that the figures used herein are the same as used for Federal income tax purposes. The return must be signed and dated. JOINT RETURNS REQUIRE BOTH SIGNATURES _______________________________________________ ________________________ _______________________________________________ __________________________ SIGNATURE OF TAXPAYER (PRIMARY) DATE SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER DATE ______________________________________________ _________________________ ______________________________________________ _________________________ SIGNATURE OF TAXPAYER (SPOUSE) DATE EMPLOYER AND ADDRESS OF PREPARER PHONE #
