NOT A FEDERAL RETURN


FILE WITH:

VILLAGE OF NEW WATERFORD
INCOME TAX DEPT
P.O. BOX 287
NEW WATERFORD, OHIO 444445

DUE DATE: APRIL 15, 2004


VILLAGE OF NEW WATERFORD INCOME TAX RETURN

  FOR CALENDAR YEAR 2003 OR FISCAL YEAR ENDED ______

  FISCAL YEAR DUE DATE: 120 DAYS AFTER END OF FISCAL PERIOD

 

PAID WITH RETURN  
$___________

PROCESSED BY
___________

DATE PROCESSED 
 ____________
CHECK YOUR STATUS AS A TAXPAYER:
EMPLOYEE __  PROFESSIONAL __  PROPRIETOR__ CORPORATION __  PARTNER __  RETIRED __  OTHER ___

TAXPAYER’S NAME, ADDRESS, TELEPHONE:

 

 

 

FEDERAL IDENTIFICATION NUMBER ___________________

EMPLOYER___________________________
ADDRESS ___________________________
EMPLOYER __________________________
ADDRESS ___________________________
S.S. NO._____________________________
S.S. NO._____________________________

IF MOVED SINCE PREVIOUS FINAL RETURN WAS DUE GIVE DATE MOVED INTO VILLAGE _________________
OUT OF VILLAGE _______________

ATTACH LEGIBLE COPY OF ALL W-2’S, 1099’S, AND/OR SCHEDULES - W2’S MUST BE SUBMITTED!
ATTACH COPIES OF FEDERAL FORMS 1120, 1120S, 1065 OR 1041 BEFORE PAYROLL DEDUCTIONS
1.  Wages, Salaries, Tips and Other Employee Compensation (Total Gross Wage)  $
2.  Other Taxable Income (Business losses cannot offset W2 Wages) $
3.  Total Taxable Income    $
4.  Municipal Tax Rate 1% of line 3  $
5.  Credits
      A.  Taxes withheld by Employers (For the Village of New Waterford) $
      B.  Estimated taxes paid to Village of New Waterford  $
      C.  Income Tax paid to ANOTHER municipality limited to 1/2 % $
      D.  Other Credits Allowed  $
      E.  Total Credits $
6.  Balance of TAX DUE (Make checks payable to Village of New Waterford) $
7.  OVERPAYMENT (If line 4 is less than 5E) $
      A.  (Please Check ) Overpayment to be refunded ___   Credited to next year Estimate __     

CERTIFICATION

I declare that the information contained in this tax return has been examined by me 
and to the best of my knowledge and belief is a true and complete return.

             __________________________________________________________________________________________________
Taxpayer Signature                             Date                         Signature of preparer other than taxpayer


_______________________________                  _________________
Taxpayer Signature                                                  Date         

 

Space

SCHEDULE X - RECONCILIATION WITH FEDERAL INCOME TAX RETURN

ITEMS NOT DEDUCTIBLE

ITEMS NOT TAXABLE - DEDUCT
A.  Capital Losses      $ F.  Capital Gains        $
B.  All Income Taxes Paid  $ G.  Interest Received  $
C.  Withdrawals by Owner  $ H.  Dividends Received $
D.   New operating loss carry forward from federal return        $ I.  Income from Royalties, Patents and Copyrights $
E.  Business loss from W-2 wage $
Total Additions (enter on line 24, page 2) $ Total Deductions (enter on line 25, page 2)  $
Form

 

Original, Tax Department Copy

 

Spa
cer

SCHEDULE C - PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

BUSINESS NAME       ________________________________________                   
BUSINESS ADDRESS ________________________________________
                                  ________________________________________

1.  TOTAL RECEIPTS, LESS ALLOWANCES, REBATES AND RETURNS  $
2.  LESS (a) Cost of Goods Sold, or (b) Cost of Operations   $
3.  GROSS PROFIT FROM SALES, ETC. (Line 1 less line 2) $
4.  DIVIDENDS $________     : INTEREST $_________    : ROYALTIES $_________  $
5.  RENTS RECEIVED, IF CONNECTED WITH BUSINESS (See Schedule G) $
6.  OTHER BUSINESS INCOME (SPECIFY) $
7.  TOTAL BUSINESS INCOME BEFORE DEDUCTIONS $
                                     BUSINESS DEDUCTIONS
8.     Compensation of Officers $
9.     Salary/wages (not deducted elsewhere) $
10.   Commissions not included in 8 or 9 $
11.   Payments to partners $
12.   Rents (paid to ______________) $
13.   Interest on business indebtedness $
14a.City/State Income Taxes $
14b.Other business taxes $
15.  Legal and Professional Fees $
16.  Bad Debts $
17.  Depreciation, Amort, Depletion $
18.  Repairs $
19.  Advertising/promotions $
20.  Auto/Truck Travel $
21.  Other $
22.  TOTAL BUSINESS DEDUCTIONS (LINE 8 - LINE 21) $
23.  NET PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION (LINE 7 LESS LINE 22)  $
24.  ADD ITEMS NOT DEDUCTIBLE (SCHEDULE X PAGE 1) $
25.  DEDUCT ITEMS NOT TAXABLE (SCHEDULE X PAGE 1)  $
26.  ADJUSTED NET INCOME $
27.  AMOUNT ALLOCABLE TO NEW WATERFORD IF SCHEDULE Y IS USED _____%  $
28.  NET PROFIT SUBJECT TO NEW WATERFORD INCOME TAX (ENTER ON LINE 3 PAGE 1) $

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SCHEDULE G - INCOME FROM RENTS (IF NOT INCLUDED IN SCHEDULE C)
(REPORT ONLY IF TOTAL POTENTIAL GROSS RENTAL INCOME EXCEEDS $200 A MONTH) *IF INCLUDED IN SCHEDULE C, LINE 5, KIND AND LOCATION OF EACH PROPERTY MUST BE SHOWN IN SCHEDULE G)

Individual renting and location of property

Amount of Rent

Depreciation

 

Repairs

 

 Net income (loss)
$ $ $ $

    TOTAL INCOME (LOSS) ENTER ON LINE 2, PAGE 1                $__________

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SCHEDULE H - OTHER INCOME NOT INCLUDED IN SCHEDULE C OR G
INCOME FROM PARTNERSHIPS, ESTATES, TRUSTS, FEES, ETC.

RECEIVED FROM

FOR (DESCRIBE)

AMOUNT

$

FARM INCOME FROM FEDERAL RETURN FORM 1040
$
TOTAL (ENTER ON LINE 4, PAGE 1)   $

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SCHEDULE Y - BUSINESS ALLOCATION FORMULA

Located Everywhere

Loc. in N. Waterford

 

Percentage

 
Avg. Value Real/Tang. Property gross rentals X8 %
Gross receipts from sales/services %
Wages, Salaries, Etc. paid %

Total Percentages

%

Average Percentage (Carry to Line 27)

%

 

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