Form 37 - Regional Income Tax Agency - Cleveland - 2003

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REGIONAL INCOME TAX AGENCY
PHONE:
CLEVELAND LOCAL (440) 526-0900
FORM
COLUMBUS LOCAL
(614) 538-0512
2003
INDIVIDUAL INCOME TAX RETURN
TDD
(440) 526-5332
37
P.O. Box 89474 Cleveland, Ohio 44101-6474
TOLL FREE
1-800-860-7482
OBTAIN FORMS AT
IF YOU ARE FILING AN AMENDED RETURN, CHECK HERE
Social Security Number
Spouse’s Social Security Number
IF YOU’VE OVERPAID, INDICATE YOUR CHOICE
INDICATE FILING STATUS BELOW:
Refund
Credit
Single
Joint
First Name
M. I.
Last Name
Spouse’s First Name
M. I.
Last Name
Address Number
Street Name
Apt. #
City
State
Zip Code
*FORM37F03A*
Daytime Phone
Evening Phone
IF YOU MOVED DURING THE YEAR, CHECK THIS BOX AND INDICATE
FORM37F03A
YOUR CHANGE OF ADDRESS BELOW
DATE OF MOVE
Month
Day
Year
CURRENT ADDRESS
Address Number
Street Name
Apt. #
City
State
Zip Code
PRIOR ADDRESS
Address Number
Apt. #
Street Name
City
State
Zip Code
List all W-2 wages earned in 2003 and the amount of Local/City Tax withheld by your Employer(s). Indicate
SECTION A
in column 4 the city in which you or your spouse worked even if it is different than what is shown on your W-2 form.
COLUMN 6
COLUMN 2-LOCAL/CITY TAX
COLUMN 5-CITY WHERE
COLUMN 1- WAGES
COLUMN 3-LOCAL/CITY TAX
COLUMN 4-CITY WHERE
WITHHELD FOR WORKPLACE.
YOU LIVED WHEN
FROM
THROUGH
LIST EACH W-2 SEPARATELY.
WITHHELD FOR RESIDENT CITY
WAGES WERE EARNED
DATE
DATE
CITY
WAGES WERE EARNED
MM DD
MM DD
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
Total wages above from rows 1-6
Total workplace withholding above
Total resident city withholding above
from rows 1-6, and enter on line 4a,
from rows 1-6, and enter on line 7a,
and enter on line 1a, Section B.
Section B.
Section B.
SIGNATURE
DATE
SPOUSE'S SIGNATURE
DATE
Preparer's Signature(Other Than Taxpayer)
DATE
ADDRESS
ID NUMBER
THE ABOVE SIGNED DECLARES THAT THIS RETURN IS TRUE, CORRECT AND COMPLETE FOR THE TAX YEAR 2003.
Page 1

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