FORM Q1 1172                                                          RETURN  WITH  PAYMENT
                                                                      QUARTERLY ESTIMATE
MAKE CHECK OR MONEY ORDER TO:                                         City of Hubbard Tax Department                                                                                                                                     AMOUNT
CITY OF HUBBARD TAX DEPARTMENT                                   MAIL P O BOX 307                                                                                                                                                        ENCLOSED$
                                                                 TO } HUBBARD  OH   44425-0307
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  330-534-6299     Fax  330-534-6282                                                                                                                          _____Quarter 2016
   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

                                  IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE - INCOME TAX OFFICE - PROMPTLYNOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE.

FORM Q11172                                                           KEEP FOR YOUR RECORDS
                                                                      QUARTERLY ESTIMATE
MAKE CHECK OR MONEY ORDER TO:                                         City of Hubbard Tax Department                                                                                                                                     AMOUNT
CITY OF HUBBARD TAX DEPARTMENT                                   MAIL P O BOX 307                                                                                                                                                        ENCLOSED$
                                                                 TO } HUBBARD  OH   44425-0307
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  330-534-6299     Fax  330-534-6282                                                                                                                          _____Quarter 2016
   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

                                  IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE - INCOME TAX OFFICE - PROMPTLYNOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE.