Form Cca-102 - Employer'S Return Of Income Tax Withheld - Central Collection Agency - Cleveland, Ohio Page 2

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GENERAL INSTRUCTIONS FOR FORM CCA – 102
WHO MUST FILE – (PSOR\HUV GRLQJ EXVLQHVV ZLWKLQ DQ\ &&$ FRPPXQLW\ ZLWK RQH RU PRUH HPSOR\HHV PXVW ¿OH DQG SD\ HPSOR\PHQW WD[ DV GH¿QHG LQ 25& 
,I \RX WHPSRUDULO\ GLVFRQWLQXH SD\LQJ ZDJHV \RX PXVW QHYHUWKHOHVV ¿OH D UHWXUQ ZLWK &&$ ,I \RX QR ORQJHU H[SHFW WR SD\ ZDJHV VXEMHFW WR WKH WD[ UHSRUWDEOH RQ WKLV IRUP \RX PXVW ¿OH D
µ),1$/ 5(7851¶ ZLWK H[SODQDWLRQ VKRZQ RQ WKH EDFN RI WKLV IRUP $IWHU \RX KDYH RQFH ¿OHG D UHWXUQ D SUHSULQWHG )RUP &&$ ZLOO EH PDLOHG WR \RX <RX PD\ DOVR GRZQORDG D EODQN
return at %H VXUH WR ¿OO LQ DOO QHFHVVDU\ LQIRUPDWLRQ LQ RUGHU WR DYRLG SHQDOW\
WHAT INCOME IS TAXABLE ± 4XDOLI\LQJ ZDJHV DV GH¿QHG LQ 25& 6HFWLRQ  7\SLFDOO\ ),&$0HGLFDUH ZDJHV DUH UHSRUWDEOH LQ %R[  RI )HGHUDO )RUP : ZLWK WZR SRVVLEOH DGGLWLRQV
for stock options and sub pay.)
PENALTY & INTEREST ± 7KH ODZ SURYLGHV SHQDOWLHV IRU ODWH ¿OLQJ RI D UHWXUQ DQG SD\PHQWV WKHUHRI 3HQDOWLHV DOVR DUH LPSRVHG E\ ODZ IRU IDLOXUH WR SD\ FROOHFW RU WUXWKIXOO\ DFFRXQW IRU
and pay over tax, keep records, make returns, for false or fraudulent returns or for submitting bad checks. Penalty rate is 10% and interest rate is 1½% per month for late payments. See
VSHFL¿F RUGLQDQFH IRU YDULDQFHV
ALLOCATION OF RESIDENCE TAXES WTIHHELD
Final Return
Municipality
Code
Tax Withheld
Municipality
Code
Tax Withheld
Municipality
Code
Tax Withheld
Municipality
Code
Tax Withheld
If this is the last
Ada
002
Geneva-on-the-Lake* 347
North Baltimore
548
Wadsworth
815
withholding report
WR EH ¿OHG ZLWK &&$
Alger
004
Grand Rapids
356
North Perry Village 555
Warrensville Hts. 830
– Please circle and
Barberton
025
Grand River
357
North Randall
560
:D\QHV¿HOG
833
enter the date of
Bradner
117
Highland Hills
371
Norton
575
change.
Bratenahl
120
Huntsville
382
Village of Oakwood 585
1. No longer
Burton
176
Liberty Center
408
Paulding
640
conducts Business
in a CCA community
Cleveland
200
Linndale
420
Peninsula
645
– enter new address
Cridersville
239
Madison Village
455
Rocky River
700
and date of change
Dresden
260
Medina
487
Russells Point
703
below.
Elida
276
Mentor-on-the-Lake 495
Seville
722
2. No longer
Frazeysburg
307
Munroe Falls
533
South Russell
772
withholding
Gates Mills
330
1RUWK¿HOG 9LOODJH 545
Timberlake
788
residence tax for
CCA community.
Total Residence Tax
3. No longer has
employees but still
conducts Business
in a CCA
(;3/$1$7,21 2) $'-8670(17 ± $PRXQW
community
4. Merged –
New Federal ID#
Adjustment for period end
Reason
5. Liquidated
6. Other
ALLOCATION OF RESIDENCE TAXES WTIHHELD
F
inal Return
Municipality
Tax Withheld
Municipality
Tax Withheld
Municipality
Tax Withheld
Municipality
Tax Withheld
Code
Code
Code
Code
If this is the last
Ada
002
Geneva-on-the-Lake* 347
North Baltimore
548
Wadsworth
815
withholding report
WR EH ¿OHG ZLWK &&$
Alger
004
Grand Rapids
356
North Perry Village 555
Warrensville Hts. 830
– Please circle and
Barberton
025
Grand River
357
North Randall
560
:D\QHV¿HOG
833
enter the date of
change.
Bradner
117
Highland Hills
371
Norton
575
1. No longer conducts
Bratenahl
120
Huntsville
382
Village of Oakwood 585
Business in a CCA
Burton
176
Liberty Center
408
Paulding
640
community – enter
new address and date
Cleveland
200
Linndale
420
Peninsula
645
of change below.
Cridersville
239
Madison Village
455
Rocky River
700
2. No longer
Dresden
260
Medina
487
Russells Point
703
withholding
Elida
276
Mentor-on-the-Lake 495
Seville
722
residence tax for CCA
community.
Frazeysburg
307
Munroe Falls
533
South Russell
772
Gates Mills
330
1RUWK¿HOG 9LOODJH 545
Timberlake
788
3. No longer has
employees but still
Total Residence Tax
conducts Business in
a CCA
NAME
community
ADDRESS
4. Merged –
(;3/$1$7,21 2) $'-8670(17 ± $PRXQW
New Federal ID#
5. Liquidated
Adjustment for period end
6. Other
Reason
DATE OF CHANGE
If Name or Address is not correct as shown, show changes above.

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