Part 1 - Account Information. Date moved out of city. Filing Status Married filing separately

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1 07LF Return with attachments due by April 7, 08 Account Part - Account Information Social Security Number Name Resident Address Mailing Address Phone Date moved into city Spouse Date moved out of city Filing Status Single Married filing jointly Married filing separately Head of Household Part - Taxable Income & Tax Calculation - Round to Whole Dollars A - W- Income Enter wages from W-s Adjustments from Worksheet A Adjustments from Worksheet D Taxable wages (subtract lines and from ) If you have no other income to report, skip to Box B - Miscellaneous Income Gambling/lottery winnings 6 Other - please explain Total miscellaneous income (add lines + 6) 7 If you have no other income to report, skip to Box C - Income from Schedules 8 Schedule C 9 Schedule E 0 Partnership/S-Corp Income Ordinary Gains Misc Other - please explain Total of schedules (add 8 - ) if loss enter 0 Newark Taxable Income (Box + Box 7 + Box ) Newark Tax (Box X 0.07) 6 Continue on back

2 Newark Tax ( Bring forward from Box 6) 7 8 Newark tax withheld on W-s 9 Other city credit (see instructions) 0 Partnership/S-Corp tax payments Part - Credit Calculation A - Withheld Tax/Other Credits Total credits (add 8-0) Newark Tax after credits (subtract Box 7-less Box ) If Box is $00 or more, see instructions for important information regarding your 08 tax. You may be required to file a 08 Estimated Tax Return. B - Estimated Tax Payments Estimated 07 tax payments Taxes carried forward from a prior year Total estimated tax payments (add +) Part - Payment/Overpayment Information 07 Tax Payment Due (Box less Box ) 6 If Box 6 is less than $0.0 - no payment due Make checks payable to: Newark City Income Tax 07 Overpayment (indicate how to apply below) 7 If Box 7 is less than $0.0 - no credit or refund Credit Account Refund I hereby declare that the information stated above is true under penalty of perjury. Signature Date Signature Date May we contact this preparer? Signature of Preparer (if different from taxpayer) Date Yes No Mail to: Newark City Tax Office PO Box 77 Newark, OH Questions? phone fax citytax@newarkohio.net

3 Worksheet A - Wage Adjustment See Worksheet A Instructions for assistance with this form. If you need to complete this form, we strongly encourage you to call for an appointment or come into our office so our staff may assist you. Part - Moved in or out of Newark in 07 W- Box b EIN A B C D E F G W- Newark Lived out A - B C D Wage Wage Worked of E F Newark Total Adjustment - Enter on line on your tax return. Part - You turned 8 in 07 A B C D E W- Box b EIN W- Wage Worked A B Under 8 Total Adjustment - Enter on line of your tax return. C D

4 Worksheet B - Other City Loss Calculation Step - Loss Adjustment A B C D E A B C Loss City Name Reported on Sch E Allowable other city loss - enter in Box D below Step - Schedule E Income Net gain or loss from income/rentals in Newark Net gain or loss from income/rentals outside any city Net gain from income/rentals in other city Net allowable city loss from above Enter this amount on Line 8 on Return Allowable Loss Gain/Loss

5 Worksheet C - Other City Credit Section - Other City Tax Return Credit If Box of your return is a loss or less than the income taxed on the other city return, do not complete this section. Please contact our office for assistance. A Name of city Tax paid Income taxed Total income taxed by other city Multiply x 0.0 Credit for filing with other cities Section - W- Credit If you had 06 Expenses, use Worksheet D to calculate this credit. City Box b EIN A B C D Worksheet A Box 8 Column E or A - B Wages G B W- credit for taxes withheld for another city E C x D C Total other city credit (Box A + Box B) The following are required to be attached to your return Copies of W-s showing other city taxes withheld Any listing of other city taxes withheld from your employer

6 Worksheet D - 06 Employee Business Expenses Beginning in 06, a new state law requires that your Employee Business Expenses be reduced by % of your Federal AGI. You are no longer allowed full credit for your If line is the only deduction reported on your 06 or 06EZ - DO NOT complete this worksheet. Adjustment to Wages Employee Business Expenses - line 0 of 06 or line 6 of 06EZ Federal Adjusted Gross Income - line 7 of 00 Multiply line by % (0.0) Allowable 06 Deduction (subtract line from line ) Enter this total onto line of your 07LF Adjustment to Credit for Taxes Paid to Other Cities A B C D E F Box b Other city Box Line B C C x D EIN wage Wage Above A - E Total other city wages 6 Other city credit after 06 Expenses x 0.0 Add total in Box 6 to total in Box C on Worksheet C and enter on line 9 on your 07LF.