Cca Form 120-18 - Application For Refund 2008
ADVERTISEMENT
1
2APPLICATION FOR REFUND
PHONE: (216) 664-2070
OHIO TOLL FREE
CCA - MUNICIPAL INCOME TAX
(year)
1-800-223-6317
205 W Saint Clair Ave
MAIL TO:
CLEVELAND, OHIO 44113-1503
Check Status:
Individual
Joint
Your social security number
Spouse’s social security number
-
IF MOVED DURING YEAR
Enter date moved:
/
/
.
MONTH
DAY
YEAR
Enter former address:
Home address (number and street)
Apt. No.
Home address (number and street)
Apt. No.
INDICATE IN BLOCK BELOW THE KIND OF CLAIM FILED (SEE INSTRUCTIONS)
Refund of municipal income tax withheld for all or part of year that Applicant was under 18 years of age. See instructions for exceptions.
A.)
B.)
/260 days) See instructions.
2106 Employee Business Expenses. (See instructions)
Other (explain)
D.)
COMPUTATION OF OVERPAYMENT
$
1.)
(Must attach W-2’s) .....................................................................................
$
2.)
$
3.)
$
4.)
$
$
$
$
7.) Estimate Paid ................................................................
8.)
$
9.)
9.)
Refund Requested.............................................................................................................................................
I DECLARE UNDER THE PENALTIES OF PERJURY THAT THIS CLAIM (INCLUDING ANY ACCOMPANYING STATEMENTS), HAS BEEN
EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS TRUE AND CORRECT.
I AUTHORIZE THE DISCLOSURE OF THE INFORMATION HEREIN TO ANY LAWFUL TAXING AUTHORITY AFFECTED BY THE REFUND.
Date
)
-
.
Date
.
Date
)
-
.
Do you authorize your preparer to contact us regarding this return? YES
NO
EMPLOYER’S CERTIFICATION (To be completed by employer)
Date
.
-
)
-
.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business