Fillable Form 37 - Rita Individual Income Tax Return printable pdf download

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RITA’s eFile

Cleveland

800.860.7482

Regional Income Tax Agency

2016

Co lumbus

866.721 .7482

Easy, Fast, Free & Secure

RITA Individual Income Tax Return

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866.750.7482

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440.526.5332

Do not use staples, tape or glue

Filing Status:

Spouse’s social security number

Your social security number

Single or Married Filing Separately

Joint

Your first name and middle initial

Last name

If you have an EXTENSION check here and attach a

If a joint return, spouse's first name and middle initial

Last name

copy:

EXTENSION

If this is an AMENDED return, check here:

CURRENT MAILING address (number and street)

Apt #

In the space provided below, state why you are filing an

AMENDED return. Attach an explanation if you require

additional space.

City, state, and ZIP code

Daytime phone number

Evening phone number

Residency Status in RITA Municipalities:

Full-Year

Part-Year

Non-Resident

City/Village/Township of Residence - Required

In the boxes below, indicate the physical location of your residence(s) for all of 2016. This may be different from your mailing address. If you moved

during 2016, list the effective date, city/village/township and address in the appropriate boxes. Why? Mailing address does not always correspond to

the city/village/township in which you live. This required information determines the appropriate taxing jurisdiction for municipal income tax purposes.

If you moved more than once, supply the additional information on a separate sheet.

Effective Date

City/Village/Township

Address

1/1/2016

Section A

List all income from W-2 wages and W-2G winnings reported in 2016 and the amount of local/city tax withheld while living in a RITA municipality. In

general, unless you moved into or out of a RITA municipality during the year, your taxable wages cannot be less than Medicare wages (Box 5 of your

W-2). List all tax withheld for your resident municipality in Column 3 only (even if you worked in the municipality where you lived). In Column 4, indicate

the name of the municipality in which you physically worked. This may be different from the employer’s address shown on the W-2. If you did not

work in a city or village enter “None” in Column 4. DO NOT ENTER SCHOOL DISTRICT TAX IN COLUMNS 2 or 3.

Co lumn 6

Co lumn 1

Co lumn 2

Co lumn 3

Co lumn 4

Co lumn 5

W- 2 / W- 2 G

Local/City Tax

Workpla c e /

Re side nt

Dates Wages

Date

Inc ome

Withheld for

Winning

Munic ipa lity

Were Earned

of winnings

(see instructions

Workplace/

Resident

Munic ipa lity

(City or village

From Date

Thru Date

Date Won

for qualifying

Winning

Municipality

(City or village

where you lived)

MM/DD/YY

wages)

Municipality

where you worked)

For Full or Part Year Residents in RITA Municipalities -

Enter Section A,

Column 1 Total onto Page 2, Line 1a; enter Column 2 Total onto Page 2, Line 4a; and

enter Column 3 Total onto Page 2, Line 7a. For Non-Residents required to file on

Totals

w orkplace w ages – Go to Page 3, Schedule K, Line 33 to calculate tax due.

Tax balances are due by April 18, 2017. Submitting an incomplete form could subject you to penalty and interest if a tax balance is

due. If you w ant RITA to calculate your taxes, please use the online eFile system at w w w . It is easy to use, secure and

Caution

w ill calculate your taxes immediately.

Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and accurately

lists all amounts and sources of municipal taxable income I received during the tax year.

Your Signature

Date

Preparer's Name (Please Print)

Date

Spouse's Signature if a joint return

Date

Preparer's Signature

ID Number

May RITA discuss this return w ith the preparer show n above?

Yes

Preparer Phone #: ______________________