Form 17 - Rita Reconciliation Of Income Tax Rita Withheld And W-2 Transmittal - Regional Income Tax Agency

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17
Regional Income Tax Agency
Cleveland
800.860.7482
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Columbus
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RITA Reconciliation of Income Tax
Youngstown
866.750.7482
TDD
440.526.5332
RITA
Withheld and W-2 Transmittal
Fax
440.922.3536
3
1
Total number of W-2’s enclosed:
Tax Year:
Total number of 1099’s enclosed:
Due on or before the last day of February of the following year.
Total number of employees working in a
RITA member municipality(ies) at year end:
Fed. ID #:
IF THIS IS AN AMENDED
Name:
RETURN CHECK HERE
OUT OF BUSINESS
Address #:
Suite:
Street Name:
MOVED OUT OF RITA
City:
State:
Zip Code:
Workplace Wages
Workplace Tax Withheld
Residence Tax Withheld
2
Period
$
$
$
January
$
$
$
February
$
$
$
March
$
$
$
April
$
$
$
May
$
$
$
June
$
$
$
July
$
$
$
August
$
$
$
September
$
$
$
October
$
$
$
November
$
$
$
December
$
$
$
0.00
0.00
0.00
4
Total
Totals must be distributed by municipality on Page 2 in Section 5.
Page
1
(if additional space is needed, attach a separate schedule)

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