Cca - Division Of Taxation 2014-City Tax Form

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CCA – DIVISION OF TAXATION
2014–City Tax Form
— Due April 15, 2015
Clear Form
216.664.2070 • 800.223.6317
Individual
Joint
Extension Attached
TAXABLE INCOME
CCA FORM 120-16-IR
CITY
INCOME
1. Employer’s Name
Social Security No.
Name
–
–
a.
Name of spouse if joint return
b.
–
–
c.
Current address
Apt. #
Move In
d.
/
/
(
)
City, State, Zip
Move Out
Attach W-2s
2.
Total Wages
or 1099s
/
/
(
)
Less Allowable
Attach Fed. 2106
3.
& Schedule A
2106 Expenses
IF MOVED DURING THE YEAR SHOW CHANGES BELOW
(
)
Line 2 less
4.
Net Taxable Wages
$0.00
Line 3
(
)
–
–
Attach
5.
Business Income
Schedule C
(
)
Attach
6.
Rental Income
Schedule E
–
–
(
)
Attach
7.
K-1 Income
Move In
Schedule E & K-1
/
/
8.
Other Income Source
Move Out
CITY OF RESIDENCE
PHONE NUMBER
(
)
–
/
/
NOTE:
IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE ORANGE SECTIONS ONLY, SIGN,
DATE, ATTACH W-2 FORMS AND MAIL RETURN. ALL OTHERS SEE INSTRUCTIONS AND COMPLETE FORM IN ITS ENTIRETY.
SECTION A
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 1
COLUMN 6
COLUMN 7
COLUMN 8
L
I
N
E
Rate
Cities
9
Select City
%
$0.00
$0.00
%
Select City
$0.00
$0.00
Select City
%
$0.00
$0.00
$0.00
Select City
%
$0.00
Total each column. Add Positive
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
10
Figures
in Column 8.
If a negative gure is sho n
CREDIT
REFUND
in Column 8, enter as
Enter amount to be
11
Enter amount to be credited to
credit or refund.
2015 here and in Column 11
refunded
SECTION A-1
COLUMN 9
COLUMN 10
COLUMN 11
COLUMN 12
COLUMN 13
12
Select City
$0.00
$0.00
$0.00
$0.00
Select City
13
Total each column.
$0.00
$0.00
SECTION B
COLUMN 20
COLUMN 14
COLUMN 18
COLUMN 19
COLUMN 16
COLUMN 17
Click here to go to calculation area
14
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total each column. Add Positive
$0.00
$0.00
$0.00
15
Figures only in Column 20.
CREDIT
If a negative gure is sho n
REFUND
16
Enter amount to be
in Column 20, enter as
Enter amount to be credited
credit or refund.
refunded
to 2015 here and in Column 23
SECTION B-1
COLUMN 21
COLUMN 23
COLUMN 24
COLUMN 22
Select City
$0.00
$0.00
Select City
$0.00
$0.00
17
$0.00
$0.00
Total each column.
$0.00
$0.00
Add Figures Shown in Last Column of Lines 10-13-15-17
18
$0.00
Write Taxpayer Identi cation Number on Remittance. Ma e chec payable to CCA.
I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX PURPOSES ADJUSTED TO MUNICIPAL INCOME TAX ORDINANCES.
Do you authorize your preparer to contact us regarding this return? YES
NO
Signature of Preparer, if not Taxpayer
Signature of Taxpayer
Signature of Spouse, if Joint Return
DATE
DATE
SIGN
HERE

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