Form 37ez - Individual Income Tax Return - Ohio Regional Income Tax Agency - 2003 Page 2
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2*FORM37EZF03B*
DATE OF MOVE
MM
DD
YYYY
FORM37EZF03B
CURRENT ADDRESS
Address Number
Street Name
Apt. #
City
State
Zip Code
PRIOR ADDRESS
Address Number
Street Name
Apt. #
City
State
Zip Code
DECLARATION OF EXEMPTION
I AM NOT REPORTING TAXABLE INCOME BECAUSE:
1.
I had NO TAXABLE INCOME for the entire tax year of 2003. (please attach a copy of page 1 of your 2003 Federal Form 1040 EZ, 1040 A, or 1040)
2.
I was a member of the ARMED FORCES of the United States and had no other taxable income the entire tax year of 2003.
3.
I was under 18 for the entire tax year of 2003.
(see special notes on page 2)
DATE OF BIRTH
MO
DAY
YR.
4.
I am a RETIRED individual, receiving only pension, social security, interest or dividend income for all of 2003.
RETIREMENT DATE
MO
DAY
YR.
5.
Prior to January 1, 2003, I moved from a RITA municipality. (please indicate previous address information in move section above)
DATE OF MOVE
MO
DAY
YR.
6.
Taxpayer is DECEASED
DATE OF DEATH
MO
DAY
YR.
7.
I am FILING JOINTLY with spouse
SPOUSE NAME
SPOUSE SOCIAL SECURITY NUMBER
RITA Municipalities
Arlington Heights
Galena
New Albany
Shaker Heights
Ashville
Garfield Heights
New Bloomington
Shawnee Hills
Aurora
Glenwillow
Newburgh Heights
Sheffield Lake
Avon
Grandview Heights
Newtown
Sheffield Village
Avon Lake
Haskins
North Lewisburg
Silver Lake
Bay Village
Highland Heights
North Olmsted
South Euclid
Beachwood
Hudson
North Royalton
South Solon
Bedford Heights
Independence
Oakwood Village
Steubenville
Bentleyville
Kirtland
Oberlin
Streetsboro
Berea
LaGrange
Olmsted Falls
Strongsville
Bexley
Lakemore
Orange
Sunbury
Boston Heights
Lakewood
Ottawa
Toronto
Brady Lake
Lockland
Pepper Pike
University Heights
Brecksville
Lyndhurst
Plain City
Upper Arlington
Broadview Heights
Maineville
Plymouth
Urbancrest
Brooklyn Heights
Maple Heights
Powell
Valley View
Cedarville
Martins Ferry
Reminderville
Vermilion
Centerburg
Marysville
Reynoldsburg
Wakeman
Chagrin Falls
Mayfield Heights
Richmond Heights
Walton Hills
Circleville
Mayfield Village
Richwood
Wellston
Cuyahoga Heights
Middleburg Heights
Ridgeway
Westlake
East Cleveland
Milan
Riverside
Willowick
Elyria
Milford Center
Saint Paris
Wintersville
Fairport Harbor
Mogadore
Salineville
Woodmere
Fairview Park
Moreland Hills
Sandusky
Worthington
Fort Jennings
Mount Sterling
Seven Hills
Yellow Springs
Page 2
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