Cca Form 120-16-Ir - Municipal Income Tax - 2008

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2008–City Tax Form

— Due April 15, 2009

EST. TAX

PAID AS OF 11/30/08

CREDIT

4TH QUARTER

90% payment due January 31, 2009

to avoid penalty and interest (see ordinance)

Clear Form

CCA–MUNICIPAL INCOME TAX

205 W SAINT CLAIR AVENUE

CLEVELAND, OHIO 44113-1503

Individual

Joint

Extension Attached

Phone: (216) 664-2070

Toll Free 1-800-223-6317

TAXABLE INCOME

CCA FORM 120-16-IR

1. Employer’s Name

CITY

INCOME

Social Security No.

Name

–

Name of spouse if joint return

–

Current address

Apt. #

Move In

(

)

City, State, Zip

Move Out

Attach W-2’s

Total Wages

or 1099’s

(

)

Less Allowable

Attach Fed. 2106

& Schedule A

2106 Expenses

IF MOVED DURING THE YEAR SHOW CHANGES BELOW

(

)

Line 2 less

Net Taxable Wages

$0.00

Line 3

(

)

Attach

–

Business Income

Schedule C

(

)

Attach

Rental Income

Schedule E

–

(

)

Attach

K-1 Income

Move In

Schedule E & K-1

Other Income Source

Move Out

PHONE NUMBER

CITY OF RESIDENCE

(

)

–

NOTE:

IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE ORANGE 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 2008

COLUMN 2

COLUMN 3

COLUMN 4

COLUMN 1

COLUMN 5

COLUMN 6

COLUMN 7

COLUMN 8

Less: Tax

Work

Work City Name

Withheld Or

Paid On

City Tax

List Each City

Less: Prior

Paid Other

Employment

Only Once

Year Credit

Tax Due CCA

Taxable Income

Rate

Tax Due

Cities

Tax Estimate

Select City

$0.00

Select City

$0.00

Select City

$0.00

Select City

Total each column. Add Positive

$0.00

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

credit or refund.

refunded here

2009 here and in Column 11

SECTION A-1

Employment / Profit Tax Estimate For 2009 (See instructions) –

must be completed to receive 2009 Estimated Bills

COLUMN 9

COLUMN 10

COLUMN 11

COLUMN 12

COLUMN 13

2008 Credit

Payment Due

Estimated

Balance

Work City

Tax Due

(From Col. 8 only)

(Col. 10 Less Col. 11)

(¼ of Col. 10 less Col. 11)

Select City

$0.00

Select City

Total Each Column

$0.00

SECTION B

Residence Tax 2008

(Refer to Schedule R Worksheet on Reverse of Form Before Proceeding to Line 14)

COLUMN 20

COLUMN 14

COLUMN 18

COLUMN 19

COLUMN 15

COLUMN 16

COLUMN 17

Less: Tax Paid

Less: Residence

Click here to go to calculation area

Tax Due

Less: Prior

On Residence

Tax Withheld

Tax Due CCA

Residence City

Year Credit

Taxable Income

Schedule R

Tax Estimate

(Attach W-2)

$0.00

Total each column. Add Positive

$0.00

Figures only in Column 20.

CREDIT

If a negative figure is shown

REFUND

in Column 20, enter as

Enter amount to be

Enter amount to be credited

credit or refund.

refunded here

to 2009 here and in Column 23

SECTION B-1

Residence Tax Estimate for 2009

(See instructions) –

must be completed to receive 2009 Estimated Bills

COLUMN 25

COLUMN 21

COLUMN 23

COLUMN 24

COLUMN 22

2008 Credit

Payment Due

Estimated

Balance

Residence City

(From Col. 20 only)

(Col. 22 Less Col. 23)

(¼ of Col. 22 less Col. 23)

Residence Tax

Select City

$0.00

Select City

$0.00

Total Each Column

$0.00

Tax Due with this return – Add Figures Shown in Last Column of Lines 10-13-15-17

$0.00

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

Signature of Preparer, if not Taxpayer

Signature of Taxpayer

Signature of Spouse, if Joint Return

DATE

SIGN

HERE