Cca Form 120-16-Ir - Municipal Income Tax - 2009
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32009–City Tax Form
— Due April 15, 2010
EST. TAX
PAID AS OF 11/30/09
CREDIT
4TH QUARTER
90% payment due January 31, 2010
to avoid penalty and interest (see ordinance)
Clear Form
CCA–MUNICIPAL INCOME TAX
205 W SAINT CLAIR AVE
CLEVELAND OH 44113-1503
Individual
Joint
Extension Attached
Phone: (216) 664-2070
Toll Free 1-800-223-6317
TAXABLE INCOME
CCA FORM 120-16-IR
CITY
1. Employer’s Name
INCOME
Social Security No.
Name
–
–
a.
Name of spouse if joint return
b.
–
–
c.
Current address
Apt. #
Move In
d.
/
/
City, State, Zip
Move Out
(
)
Attach W-2’s
2.
Total Wages
or 1099’s
/
/
Less Allowable
(
)
Attach Fed. 2106
3.
2106 Expenses
& Schedule A
IF MOVED DURING THE YEAR SHOW CHANGES BELOW
(
)
Line 2 less
4.
Net Taxable Wages
$0.00
Line 3
–
–
Attach
(
)
5.
Business Income
Schedule C
(
)
Attach
6.
Rental Income
Schedule E
–
–
(
Attach
)
7.
K-1 Income
Move In
Schedule E & K-1
/
/
8.
Other Income Source
Move Out
CITY OF RESIDENCE
PHONE NUMBER
(
)
–
/
/
NOTE:
IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE RED SECTIONS ONLY, SIGN,
DATE, ATTACH W-2 FORMS AND MAIL RETURN. ALL OTHERS SEE INSTRUCTIONS AND COMPLETE FORM IN ITS ENTIRETY.
SECTION A
Employment / Profit Tax 2009
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 1
COLUMN 5
COLUMN 6
COLUMN 7
COLUMN 8
L
I
Less: Tax
Less: Tax
Work
Work City Name
Withheld Or
Paid On
N
City Tax
List Each City
Less: Prior
Paid Other
Employment
E
Only Once
Year Credit
Tax Due CCA
Taxable Income
Rate
Tax Due
Cities
Tax Estimate
%
9
Select City
$0.00
$0.00
%
$0.00
$0.00
Select City
$0.00
$0.00
%
Select City
$0.00
$0.00
Select City
%
Total each column. Add Positive
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
10
Figures only in Column 8.
If a negative figure is shown
CREDIT
REFUND
in Column 8, enter as
Enter amount to be
Enter amount to be credited to
B
11
A
credit or refund.
2010 here and in Column 11
refunded here
SECTION A-1
Employment / Profit Tax Estimate For 2010 (See instructions) –
must be completed to receive 2010 Estimated Bills
COLUMN 9
COLUMN 10
COLUMN 11
COLUMN 12
COLUMN 13
Payment Due
Estimated
2009 Credit
Balance
Work City
(From Col. 8 only)
(¼ of Col. 10 less Col. 11)
Tax Due
(Col. 10 Less Col. 11)
12
Select City
$0.00
$0.00
$0.00
$0.00
Select City
Total Each Column
$0.00
$0.00
13
SECTION B
Residence Tax 2009
(Refer to Schedule R Worksheet on Reverse of Form Before Proceeding to Line 14)
COLUMN 18
COLUMN 19
COLUMN 20
COLUMN 14
COLUMN 15
COLUMN 16
COLUMN 17
Click here to go to calculation area
Less: Tax Paid
Less: Residence
Tax Due
Less: Prior
On Residence
Tax Withheld
Year Credit
Tax Due CCA
Residence City
Tax Estimate
Taxable Income
Schedule R
(Attach W-2)
14
$0.00
$0.00
$0.00
$0.00
$0.00
Total each column. Add Positive
$0.00
$0.00
$0.00
15
Figures only in Column 20.
CREDIT
If a negative figure is shown
REFUND
in Column 20, enter as
A
B
Enter amount to be
16
Enter amount to be credited
credit or refund.
refunded here
to 2010 here and in Column 23
SECTION B-1
Residence Tax Estimate for 2010
(See instructions) –
must be completed to receive 2010 Estimated Bills
COLUMN 23
COLUMN 25
COLUMN 21
COLUMN 22
COLUMN 24
2009 Credit
Balance
Payment Due
Estimated
(¼ of Col. 22 less Col. 23)
Residence City
(From Col. 20 only)
(Col. 22 Less Col. 23)
Residence Tax
$0.00
Select City
$0.00
$0.00
Select City
$0.00
$0.00
$0.00
$0.00
$0.00
Total Each Column
17
Tax Due with this return – Add Figures Shown in Last Column of Lines 10-13-15-17
$0.00
18
Write Taxpayer Identification Number on Remittance. Make check payable to CCA.
I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX PURPOSES ADJUSTED TO MUNICIPAL INCOME TAX ORDINANCES.
@
@
Do you authorize your preparer to contact us regarding this return? YES
NO
Signature of Taxpayer
Signature of Spouse, if Joint Return
DATE
Signature of Preparer, if not Taxpayer
DATE
SIGN
HERE
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