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 # 

WORKSHEET A   – SALARIES AND WAGES (W2 INCOME) 
 
                              Column 1                                      Column 2                                                          Column 3        Column 4  
                           Employer, City, State                            Income From                                                    Mansfield Tax  Other City Tax 
                                                                            Each W-2                                                          Withheld        Withheld 
A.                                                                                                                                                                       
B.                                                                                                                                                                       
C.                                                                                                                                                                       
D.                                                                                                                                                                       
Totals                                                                                                                                                                   
 
WORKSHEET B – OTHER INCOME 
 
1.  Schedule C (Income found on your federal schedule C) 
      
                (A)                                       (B)                                                                          (C)          (D)        (C times D) 
             Business Name                         Business Address                  Net Profit/                                                   Allocation  Amount 
                                                                                                                                       (Loss)     Percentage  Subject to Tax 
A.                                                                                                                                                             
B.                                                                                                                                                             
 
                                                                                                                                       TOTAL (1)   $___________________ 
 
2.  Schedule E  –Income From Rentals (Income found on your federal schedule E)              TOTAL (2)  $ ___________________ 
 
3.  Schedule O  –Other Income Not Included in Schedules C or E (Income from Partnerships, Estates, Trusts, S-Corp,Tips, 1099’S, etc.) 
 
 Received from Name/ID#                          For (Description and/or Location)                                                                        Amount 
A.                                                                                                                                                 
B.                                                                                                                                                 
 
                                                                                                                                      TOTAL (3)   $ ___________________ 
 
TOTAL OTHER INCOME(ADD LINES 1  –3) ENTER HERE AND ON LINE 2 (ON FRONT)             TOTAL        $ ___________________ 
 
NOTE:    The  net  loss  from  an  unincorporated  business  activity  may  not  be  used  to  offset  salaries,  wages,  commissions  or  other 
compensation (W-2 statement).  However, if a taxpayer is engaged in two or more taxable business activities to be included on the same 
return, the net loss of one unincorporated business activity may be used to offset the profits of another for purposes of arriving at overall 
net profits. (Line 5 (on front) cannot be less than zero, if you have W-2 income). 
 
WORKSHEET C   – ADJUSTMENTS TO INCOME (Part year residents, credits for taxpayers 65 and older, income 
not subject to tax, etc. See instructions for detail) 
 
                                           Explanation                                                                                                   Deductions 
                                                                                                                                                   
                                                                                          Net Adjustment (enter on Line 4 on front)               $ 
 
ATTACHMENTS REQUIRED WITH ALL RETURNS:  W-2’S AND FEDERAL 1040 
 
IMPORTANT:  It is mandatory to file a declaration of estimated taxes and make estimated payments if you expect to owe $200.00 or 
more in taxes, also please read instructions on who must file and what is taxable or non-taxable income.