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                                           Checkbox 5: Non-Resident                        MyAccount walks you through filing 
General      Instructions                  You must provide a list of all addresses        your  form  and provides you with a 
Proof of exemption must be submitted       where you lived for the years included          confirmation  number when you are 
when required  (see the Specific           in this form.  Use the Moves Worksheet          done. 
                                                                                            
Instructions below).                       in the  Instructions and attach  to your 
                                                                                           Submit Paper Documents 
Failure to respond may result in a tax     submission.                                     If submitting a paper tax return with this 
liability  finding  based  on  information Exact  move  dates  are  not  necessary,        form, you must  submit  copies of the 
supplied to us by the Internal Revenue     but the  addresses should be within a           documents required for the type  of 
Service or  may result in  a subpoena      week or two of your actual move dates.          exemption claimed: birth certificate, 
being  issued,  requiring  you  to  appear Provide documentation proving you               driver’s license, pages  1  & 2 and 
and produce documents for inspection.      lived at each address such as copies of         Schedule 1 of your Federal Form 1040, 
Any  penalties  and  interest  owed  will  utility  bills,  property  tax  bills,  leases, death  certificate, etc.  Documents will 
continue to accrue until returns are filed deeds, or print-outs of property transfer       not be returned.  Mail your documents 
                                           records  from  the  County  Auditor’s           to: 
and any tax due is paid.                    website.                                       REGIONAL INCOME TAX AGENCY 
Specific Instructions                      If you lived in another RITA municipality       PO BOX 94801 
Checkbox 1: No Taxable Income              during any of the years covered by this          Cleveland, OH 44101-4801 
You must provide acceptable proof          form,  you are  still required to file an 
such as a copy of page 1 of your federal   Individual Tax return for the year(s) in        Contact RITA 
Form 1040 for any year you claim you       question.   A current list  of RITA             Tax forms, instructions,  and the 
had no taxable income.                     municipalities  can       be   found    at      answers to  many questions can  be 
Note that you  cannot claim an             www.ritaohio.com.  Click on the RITA            found  at www.ritaohio.com. 
exemption from filing for no taxable        Municipalities link.                           Phone:    (800) 860-7482 
income for any year for which you had      If you are (were) not a resident  of  a         TDD:      (440) 526-5332 
a rental loss, pass-through partnership    RITA municipality for any or all of the 
loss, or self-employment loss.             year(s) covered by this form, you must          Moves Worksheet 
                                           still file a return if you earned income in     Use this worksheet to report your move 
Checkbox 2: US Armed Forces                a  RITA  municipality  and  did  not  have      history for the years  covered by this 
If you would have met the requirements     tax withheld from those earnings to that        form.  Attach a separate sheet if more 
of reason 1 except you received one or     municipality  and/or  if  you  own  rental      space  is needed. 
more  W2  forms,  but  those  W2  forms 
                                           property or conduct business in a RITA 
reported     only military     pay and                                                      Move In Date      Move Out Date 
                                           municipality  and reported losses for 
allowances  for  the  year,  check  this 
                                           federal tax purposes. 
reason  for  your  exemption.   Civilian    
                                                                                            Street Address 
employees of the armed forces are not      Checkbox 6: Deceased 
eligible for this exemption.               Enclose a copy of the death certificate. 
                                            
                                                                                            City, State, ZIP 
Checkbox 3: Age Exempt                     Checkbox 7: Filing Jointly 
This exemption  is not available in all    Check this reason if you  are not 
                                                                                            
RITA      municipalities.      Go    to    exempt and are filing jointly. Complete          Move In Date      Move Out Date 
www.ritaohio.com and click on the RITA     your spouse’s  information in the 
Municipalities  link to look  up your      address section of this form. 
municipality to see if this exemption       
                                                                                            Street Address 
applies  to your municipality.             How to File 
Checkbox 4: Retired                        Efile Using RITA’s FastFile.                     City, State, ZIP 
You must provide acceptable proof          FastFile is easy, fast & secure. FastFile 
such as a copy of page 1 of your federal   does not require a  user  name or 
Form 1040 for any year you claim you       password.  You do need to have all your          
                                                                                            Move In Date      Move Out Date 
                                           tax documents in front of you for any 
had retirement income only.                year you  are  FastFiling as once you 
Note that if you are retired from your     start  a  return  it  must  be  finished  in  a  Street Address 
main  place  of  employment  but  have     single session. 
picked up a job in retirement, this 
exemption will not apply to any year in    FastFile  walks  you  through  filing  your      City, State, ZIP 
                                           return and provides you with a 
which you receive a W2.                    confirmation  number when you are                
This exemption will also not  apply to     done.                                            Move In Date      Move Out Date 
any year in  which you own rental           
property or report a partnership gain or   Efile Using RITA’s MyAccount 
loss on your federal return.               MyAccount requires you to setup a user           Street Address 
                                           name and password.  You do not need 

                                           to complete a return in a single session.        City, State, ZIP 
                                            






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