Net Profit Estimate - Central Collection Agency Division Of Taxation

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CENTRAL COLLECTION AGENCY
DIVISION OF TAXATION
Municipal Income Tax Forms
CLEVELAND OH 44113-1503
(216) 664-2070
(800) 223-6317
1HW 3URÀW (VWLPDWH
Due April 15, 2014
Name of Business
)HGHUDO ,GHQWL¿FDWLRQ 1XPEHU
Address
Trade Name
Address
Local Business Address
City, State, Zip
3ULQFLSDO %XVLQHVV $FWLYLW\ &RGH
(VWLPDWH IRU &DOHQGDU <HDU (QG  25 )LVFDO <HDU (QG %HJLQQLQJ
(QGLQJ
5
6
5
6
3
4
3
4
2
2
1
1
BALANCE
3$<0(17'8(
BALANCE
3$<0(17'8(
ESTIMATED
35,25<($5
ESTIMATED
35,25<($5
ESTIMATED
¼ OF COL. 3
ESTIMATED
¼ OF COL. 3
CODE
CODE
081,&,3$/,7<
081,&,3$/,7<
$118$/7$;
CREDIT
$118$/7$;
CREDIT
7$; '8(
LESS COL. 4
7$; '8(
LESS COL. 4
Ada
002
Munroe Falls
533
Alger
004
1RUWK¿HOG 9LOODJH
545
Barberton
025
North Baltimore
548
Bradner
117
1RUWK 3HUU\ 9LOODJH 555
Bratenahl
120
North Randall
560
Burton
176
Norton
575
Cleveland
200
Oakwood
585
3DXOGLQJ County)
Dresden
260
3DXOGLQJ
640
Elida
276
3HQLQVXOD
645
Frazeysburg
307
Rocky River
700
Gates Mills
330
5XVVHOOV 3RLQW
703
Geneva-on-the-Lake 347
Seville
722
Grand Rapids
356
South Russell
772
Grand River
357
Timberlake
788
Highland Hills
371
Wadsworth
815
Huntsville
382
Warrensville Heights 830
Liberty Center
408
:D\QHV¿HOG
833
Linndale
420
West Liberty
837
Madison Village
455
Medina
487
TOTALS
Mentor-on-the-Lake 495
I have examined this declaration and to the best of my knowledge, it is correct.
Do you authorize your preparer to contact us regarding this return?
#
#
YES
NO
6LJQDWXUH RI 2I¿FHU RU 3DUWQHU
'DWH
6LJQDWXUH RI 3HUVRQ RU )LUP 3UHSDULQJ WKH )RUP
(Date)
Title
$GGUHVV RI 3UHSDUHU
.((3 $ &23< )25 <285 5(&25'6
NO Payment Enclosed - Mail to:
Payment Enclosed - Mail to:
Refund Request - Mail to:
Central Collection Agency
Central Collection Agency
Central Collection Agency
MAIL
32 %2; 
TO
32 %2; 
32 %2; 
Cleveland OH 44101-4520
Cleveland OH 44101-4810
Cleveland OH 44101-4723

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