Cca Form 120-18 - Application For Refund Page 2
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1
2RESET WORKSHEET
WORKSHEET FOR MULTIPLE EMPLOYERS
Wages and Taxes Reported on W-2 Form:
Employer’s Name
Wages per W-2
Tax Withheld
City Name
1.)
Select City
$
$
2.)
Select City
$
$
Select City
3.)
$
$
+
+
Total Wages:
Total Tax Withheld:
0.00
0.00
$
$
enter on front page Line 1
enter on front page Line 5
Adjustments to Taxable Income:
-
=
Wages per W-2
Wages not Subject to Tax
Net Taxable Wages
1.)
-
=
0.00
$
$
$
2.)
0.00
-
=
$
$
$
-
=
0.00
3.)
$
$
$
+
+
Total Net Taxable Wages:
0.00
0.00
$
$
enter on front page Line 2
enter on front page Line 3
To complete this section, do either of the following: forcurrent rates, select the CCA city from
Computation of Corrected Tax:
the drop-down list. For past rates, manually type the rate in the Tax Rate field.
City Worked
Net Taxable Wages
Tax Rate
Corrected Tax
1.)
0.00
Select City
0.00
Look up City Rate
X
=
$
%
$
2.)
0.00
0.00
Select City
$
%
$
X
=
X
0.00
=
0.00
Select City
3.)
$
%
$
+
0.00
$
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