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Village
of New Waterford Income Tax Department
3760 Village Park Drive P.O. Box 287
New Waterford, Ohio 44445
330-457-2225
YEAR
_____________
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INDIVIDUAL DECLARATION OF EXEMPTION OF
NEW WATERFORD, OHIO VILLAGE INCOME TAX
The filing of the declaration will
satisfy your obligation, as imposed by the Village of New Waterford
Income
Tax Ordinance to file an Annual Municipal Income Tax Return, if
you qualify for one of the following categories.
If any of the categories shown below
apply,
check the appropriate block, sign, and file this form by April 15th.
Compliance will avoid being considered a DELINQUENT TAXPAYER.
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YOUR NAME___________________
SOCIAL SECURITY NUMBER_________________
SPOUSE’S NAME____________________________
SPOUSE’S SOCIAL SECURITY NUMBER _________________
PRESENT HOME ADDRESS ______________________
CITY, STATE, ZIP CODE _______________________
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I am qualified to file a New
Waterford Income tax exemption return because:
_____ I am working but will not turn 18 until
________
_____ Unemployed, no earned income for the entire
tax year of _______
Circle income source:
Unemployment
Welfare
ADC
Other _______________
_____ Member
of the Armed Forces of the United States of America for the entire years
of _______
(This
does not include civilians employed by the Military or National Guard)
_____ Retired. No income subject to New Waterford Income Tax for the entire tax
year of ______ I received
only Social
Security pension, interest, or dividend income.
I do not own rental property. I am not self-employed.
I
understand that I must file a New Waterford Income Tax Return if any of
these conditions change in future years.
Date Retired:
_______
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I DECLARE THE INFORMATION SUPPLIED
ABOVE TO BE TRUE, CORRECT, AND COMPLETE.
_______________________
__________
________________________
_________ SIGNATURE
DATE
SPOUSE’S
SIGNATURE
DATE
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