Form 37ez - Individual Income Tax Return - Ohio Regional Income Tax Agency - 2003

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P
PHONE:
CLEVELAND LOCAL
(440) 526-0900
FORM
REGIONAL INCOME TAX AGENCY
COLUMBUS LOCAL
(614) 538-0512
TDD
(440) 526-5332
2003
INDIVIDUAL INCOME TAX RETURN
37EZ
TOLL FREE
1-800-860-7482
P.O. Box 89474 Cleveland, Ohio 44101-6474
OBTAIN FORMS AT
IF YOU ARE EXEMPT FROM FILING, CHECK THS BOX AND FILL OUT
THE DECLARATION OF EXEMPTION ON THE BACK OF THIS FORM
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.
Spouse’s Last Name
Address Number
Street Name
Apt. #
City
State
Zip Code
Daytime Phone
Evening Phone
*FORM37EZF03A*
FORM37EZF03A
IF YOU MOVED IN 2003, CHECK THIS BOX AND INDICATE
YOUR CHANGE OF ADDRESS ON THE BACK OF THIS FORM
List all W-2 wages earned in 2003 and the amount of Local/City Tax withheld by your Employer(s).
Indicate
WAGE INFORMATION
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 1-WAGES
COLUMN 2-LOCAL/CITY TAX
COLUMN 3-LOCAL/CITY WHERE
COLUMN 4-CITY WHERE
COLUMN 5-CITY WHERE YOU
COLUMN 6
FROM
THROUGH
LIST EACH W-2 SEPARATELY.
WITHHELD FOR WORKPLACE CITY
WITHHELD FOR RESIDENT CITY
WAGES WERE EARNED
LIVED WHEN WAGES WERE
DATE
DATE
EARNED
MM
DD
MM
DD
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
RITA WILL COMPUTE YOUR 2003 TAX DUE AND, WHEN REQUIRED BY ORDINANCE, YOUR 2004 ESTIMATE.
DO NOT SEND PAYMENT WITH THIS FORM.
YOU WILL BE BILLED FOR ANY TAX DUE.
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.
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