Withholding And Business Registration Cca - Municipal Income Tax - City Of Cleveland

W I TH H O LD I N G A N D B U SI N ESS R EG I STR ATI O N

CCA – MUNICIPAL INCOME TA X

1701 Lakesi de Avenue

C l evel and, O hi o 44114- 1118

Phone: 216- 664- 2070, 1- 800- 223- 6317

www. ccat ax. ci . cl evel and. oh. us

D ATE B U SI N ESS STA R TED

PHONE NO.

FEDERAL IDENTIFICATION NUMBER

N A M E O R C O R PO R ATE N A M E

B U SI N ESS O R TR A D E N A M E

B U SI N ESS A D D R ESS I N TA XI N G C O M M U N I TY

M A I LI N G A D D R ESS

AD D R ESS O F O U TSI D E AC C O U N TAN T SH O U LD N O T BE U SED

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C H EC K B U SI N ESS TYPE

SOLE PROPRIETOR**

C O R PO R ATI O N

PA R TN ER SH I P

LI M I TED LI A B I LI TY C O

S- C O R PO R ATI O N

N O N - PR O FI T C O R P

ESTATE O R TR U ST

G O VER N M EN TA L

FI N A N C I A L O R G .

U N I O N

O TH ER

( D et ai l )

**IF SOLE PROPRIETOR YOU MUST COMPLETE BOTH SIDES OF THIS FORM

I t i s your r esponsi bi l i t y t o advi se t hi s of f i ce of any changes i n your st at us

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W i l l you be w i t hhol di ng em pl oym ent t axes?

Yes

N o

For w hat ci t y( s)

M or e t han $100 per m ont h?

Yes

N o

N um ber of em pl oyees i n C C A ?

Fi r st payr ol l dat e

W i l l you be w i t hhol di ng r esi dence t axes?

Yes

N o

Type of busi ness ( M f g. , C om m er ci al , et c. )

Fi scal Per i od endi ng m ont h

N am e of per son r esponsi bl e f or f i l i ng f or m s:

N am e

Ti t l e

Phone N o.

Si gnat ur e

D at e

MEMBERS

Ada

Creston

Grand River

Mentor

North Perry

Peninsula

Timberlake

Andover

Dunkirk

Highland Hills

Mentor-on-the-Lake

North Randall

Perry

Wadsworth

Bratenahl

Euclid

Liberty Center

Metamora

Village of Oakwood

Rock Creek

Warrensville Hts.

Burton

Gates Mills

Linndale

Middlefield

Orwell

Rocky River

Willoughby

Chardon

Geneva-on-the-Lake

Madison Village

Northfield Village

Painesville

Seville

Willoughby Hills

Cleveland

Grand Rapids

Medina

North Baltimore

Paulding

South Russell