Form Cca-102 - Employer'S Return Of Income Tax Withheld - Central Collection Agency - Cleveland, Ohio

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EMPLOYER’S RETURN
 : 6$,17 &/$,5 $9( ‡ &/(9(/$1' 2+,2 
OF INCOME TAX WITHHELD
3+21(  
72// )5((  
SPECIFIC INSTRUCTIONS
Line 1 - (QWHU WKH WRWDO WD[DEOH HPSOR\PHQW ZDJHV DV GH¿QHG LQ 25&  'R QRW LQFOXGH ZDJHV IURP LQGLYLGXDOV XQGHU WKH DJH RI  ([FHSWLRQV *UDQG 5LYHU DQG 0HGLQD XQGHU WKH
age of 16, Geneva-On-The-Lake under the age of 15. Do not include wages earned in taxing communities not listed on this form.
Line 2 - Enter the amount of employment tax withheld. See employment city for tax rate. Allocation of employment tax withheld must be detailed on the front of this form.
Line 3 - Enter the amount of residence tax withheld. Allocation of residence tax must be detailed on the reverse of this form.
Line 4 - Adjustment of income tax withheld. –Line 4 should be used for the correction of errors made in withholding of income tax from wages paid in prior quarters. Any amount shown on
Line 4 must be explained on the reverse of this form.
Line 5 - Balance Due / Paid herewith. Please make checks payable to the Central Collection Agency. The amount indicated must be paid with the return by the due date indicated and
allocated to the City of Employment unless work is performed in a non-taxing area. Tax withheld in a non-taxing area reverts back to the City of Residence of the employee.
Signature -6LJQ GDWH DQG HQWHU SKRQH QXPEHU EHIRUH UHWXUQLQJ WKLV IRUP $ UHWXUQ LV QRW FRQVLGHUHG ¿OHG XQWLO VLJQHG 1DPH DQG $GGUHVV FKDQJHV VKRXOG EH PDGH RQ WKH UHYHUVH RI WKLV IRUP
Date Due -$OO ¿OLQJV DUH GXH E\ WKH WK GD\ IROORZLQJ WKH HQG RI WKH ZLWKKROGLQJ SHULRG 6HH VSHFL¿F RUGLQDQFH IRU YDULDQFHV
ALLOCATION OF EMPLOYMENT AND RESIDENCE TAX REMITTED
MUST BE COMPLETED TO AVOID PENALTY
(PSOR\HUV ZKLFK ZLWKKROG  RU PRUH SHU PRQWK PXVW ¿OH PRQWKO\
*HQHYD2Q7KH/DNH UHTXLUHV DOO HPSOR\HUV ¿OH PRQWKO\
1. Total Employment Wages
2. Total Employment Taxes
Subject to Withholding
(allocate below)
Emp Code
FEDERAL ID #
File Code
3. Total Residence Taxes
Name
(allocate on reverse)
For the period
4. Adjustments
Current Address
(explain on Reverse)
To
'XH RQ RU EHIRUH
5. TOTAL TAXES
ALLOCATED
City
State
Zip
Make checks payable to CCA.
$//2&$7,21 2) (03/2<0(17 7$; :7,++(/'
Municipality
Tax Withheld
Municipality
Tax Withheld
Municipality
Tax Withheld
Municipality
Tax Withheld
Rate% Code
Rate% Code
Rate% Code
Rate% Code
Ada
1.65 002
Geneva-on-the-Lake* 1.5 347
North Baltimore
1 548
Wadsworth
1.4 815
Alger
1 004
Grand Rapids
1 356
North Perry Village
1 555
Warrensville Hts. 2.6 830
Barberton
2 025
Grand River
2 357
North Randall
2.75 560
:D\QHV¿HOG
1 833
Bradner
1 117
Highland Hills
2.5 371
Norton
2 575
Bratenahl
1.5 120
Huntsville
1 382
Village of Oakwood
1 585
Burton
1 176
Liberty Center
1 408
Paulding
.5 640
Revenue Sharing/JEDD/JEDZ (complete below)
Cleveland
2 200
Linndale
2 420
Peninsula
1 645
Liberty Center
1 986
Cridersville
1 239
Madison Village
1 455
Rocky River
1.5 700
Medina/Montvll
1.25 987
Dresden
1 260
Medina
1.25 487
Russells Point
1 703
Cleve/High Hills
2.5 995
Elida
.75 276
Mentor-on-the-Lake
2 495
Seville
1 722
High Hills/Cleve
2.5 996
Frazeysburg
1 307
Munroe Falls
2 533
South Russell
1.25 772
Warr Hts/Cleve
2.6 997
Gates Mills
1 330
1RUWK¿HOG 9LOODJH
2 545
Timberlake
1 788
EMPLOYERS WHICH WITHHOLD $100.00
SHOW CHANGE OF ADDRESS OR CHANGE OF
OR MORE PER MONTH MUST FILE MONTHLY.
FILING STATUS ON THE REVERSE SIDE OF THIS FORM
*HQHYD2Q7KH/DNH UHTXLUHV DOO HPSOR\HUV ¿OH PRQWKO\
&(175$/ &2//(&7,21 $*(1&< ‡ ',9,6,21 2) 7$;$7,21
EMPLOYER’S RETURN OF INCOME TAX WITHHELD
 : 6$,17 &/$,5 $9( ‡ &/(9(/$1' 2+,2 03
2. Total Employment Taxes
1. Total Employment Wages
Subject to Withholding
(allocate below)
Emp Code
FEDERAL ID #
File Code
3. Total Residence Taxes
(allocate on reverse)
For the period
4. Adjustments
To
(explain on Reverse)
'XH RQ RU EHIRUH
5. TOTAL TAXES
Signature
Title
Co. Phone
Date
ALLOCATED
I have examined this return and to the best of my knowledge, it is correct and complete
$//2&$7,21 2) (03/2<0(17 7$; :7,++(/'
Make checks payable to CCA.
Municipality
Rate% Code
Tax Withheld
Municipality
Rate% Code
Tax Withheld
Municipality
Rate% Code
Tax Withheld
Municipality
Rate% Code
Tax Withheld
Ada
1.65 002
Geneva-on-the-Lake* 1.5 347
North Baltimore
1 548
Wadsworth
1.4 815
Alger
1 004
Grand Rapids
1 356
North Perry Village
1 555
Warrensville Hts. 2.6 830
Barberton
2 025
Grand River
2 357
North Randall
2.75 560
:D\QHV¿HOG
1 833
Bradner
1 117
Highland Hills
2.5 371
Norton
2 575
Bratenahl
1.5 120
Huntsville
1 382
Village of Oakwood
1 585
Burton
1 176
Liberty Center
1 408
Paulding
.5 640
Revenue Sharing/JEDD/JEDZ (complete below)
Cleveland
2 200
Linndale
2 420
Peninsula
1 645
Liberty Center
1 986
Cridersville
1 239
Madison Village
1 455
Rocky River
1.5 700
Medina/Montvll
1.25 987
Dresden
1 260
Medina
1.25 487
Russells Point
1 703
Cleve/High Hills
2.5 995
Elida
.75 276
Mentor-on-the-Lake
2 495
Seville
1 722
High Hills/Cleve
2.5 996
Frazeysburg
1 307
Munroe Falls
2 533
South Russell
1.25 772
Warr Hts/Cleve
2.6 997
Gates Mills
1 330
1RUWK¿HOG 9LOODJH
2 545
Timberlake
1 788

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