Form 17b - Reconciliation Of Return Of Income Tax Withheld

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Regional Income Tax Agency
Form
Reconciliation of Return of Income Tax Withheld
17B
For the period 07-01-01 to 12-31-01
WAGES SUBJECT TO
WORKPLACE
RESIDENCE
PERIOD
WORKPLACE TAX
TAX WITHHELD
TAX WITHHELD
Due on or before 02-15-2002
JULY
____________
____________
____________
AUGUST
____________
____________
____________
FED. ID #
__________________________________
SEPTEMBER
____________
____________
____________
NAME
__________________________________
OCTOBER
____________
____________
____________
ADDRESS __________________________________
NOVEMBER
____________
____________
____________
__________________________________
DECEMBER
____________
____________
____________
*TOTAL
____________
____________
____________
__________________________________
*Must distribute by city below
WORKPLACE
TAX
WORKPLACE
RESIDENCE
WORKPLACE
TAX
WORKPLACE
RESIDENCE
MUNICIPALITY
WAGES
RATE
TAX
TAX
MUNICIPALITY
WAGES
RATE
TAX
TAX
Ashville
.50
Mt. Sterling
1.00
Aurora
1.00
New Albany
1.00
Avon
1.00
Newburgh Hts.
2.00
Avon Lake
1.50
Newtown
1.00
Bay Village
1.50
North Lewisburg
1.00
Beachwood
1.50
North Olmsted
2.00
Beachwood East JEDD
1.50
North Royalton
1.00
Beachwood West JEDD
1.50
Oakwood Village
2.00
Bedford Hts.
2.00
Olmsted Falls
1.50
Bentleyville
1.00
Orange
2.00
Berea
2.00
Orange-Chagrin
Bexley
2.00
Highlands JEDD
2.00
Boston Hts.
1.50
Ottawa
1.00
Brady Lake
1.00
Pepper Pike
1.00
Brecksville
2.00
Plain City
1.00
Broadview Hts.
2.00
Powell
.75
Brooklyn Hts.
2.00
Reminderville
1.50
Chagrin Falls
1.50
Reynoldsburg
1.50
Cuyahoga Hts.
1.50
Richmond Hts.
2.00
East Cleveland
2.00
Richwood
.50
Elyria
1.75
Riverside
1.50
Fairview Park
1.50
St. Paris
1.00
Galena
1.00
Salineville
1.00
Garfield Hts.
2.00
Seven Hills
2.00
Glenwillow
2.00
Shaker Hts.
1.75
Grandview Hts.
2.00
Shawnee Hills
2.00
Highland Hts.
1.50
Sheffield Village
1.00
Hudson
1.00
Silver Lake
2.00
Hunting Valley
.75
South Euclid
1.50
Independence
2.00
South Solon
1.00
Kirtland
1.00
Steubenville
2.00
LaGrange
1.50
Streetsboro
1.00
Lakemore
2.00
Strongsville
2.00
Lakewood
1.50
Sunbury
1.00
Lockland
2.10
Toronto
1.50
Lyndhurst
1.50
University Hts.
1.50
Maple Hts.
2.00
Upper Arlington
2.00
Mayfield Hts.
1.00
Valley View
2.00
Mayfield Village
1.50
Vermilion
1.00
Middleburg Hts.
1.75
Wakeman
1.00
Milan
.50
Walton Hills
1.00
Milford Center
1.00
Westlake
1.50
Mogadore
2.00
Willowick
2.00
Moreland Hills
1.00
Wintersville
1.00
Mt. Gilead
1.00
Woodmere
2.00
TOTAL
MUST EQUAL TOTALS FROM LINE 4
I HAVE EXAMINED THIS RETURN AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT.
X
SIGNATURE
________________________________________________________
TITLE _________________________________________________________________
DATE__________________________ PHONE # (______)________________

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