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a return envelope.

www.ccatax.ci.cleveland.oh.us

2023
TAX FORM
INDIVIDUAL

INSTRUCTION BOOKLET

CCA – DIVISION OF TAXATION Additional information may be obtained at 

         MUNICIPAL INCOME TAX
This packet includes a 2023 City Tax form, Exemption Certificate, instructions and The 2023 Return is due April 15, 2024. For the tax year 2023, 90% of the tax due must be paid by January 15, 2024 to avoid penalty and interest (subject to municipal ordinance). Estimated payments and prior year credits may be reviewed 24/7 online at https:// efile.ccatax.ci.cleveland.oh.us or by calling 216-664-2070, option 2. Attach your remittance to the front of the form. Make checks payable to CCA – Division of Taxation.



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                                                                             their CCA 

         CCA eFile

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Visit our web site for details

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         www.ccatax.ci.cleveland.oh.us

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Business (Schedules C or F) Rental or K-1 activity (Schedule E) Overpayment (Refund or Credit) W2 from one employer listing multiple cities 1099-NEC from one business with income earned in multiple cities                                        Residence Tax withheld by the employer 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     If you have any of the following, you cannot use eFile to file an Individual City Tax Form 
                                                                                                                                                                                                                                               2023 Individual Exemption Certificate Use this electronic form if you had no earned income for the entire year. 2023 Individual Annual City Tax Form Individual Estimated Payment Tax, Penalty and/or Interest Payment Review account estimate and credit information                                                                                                                                                                                     at this time. You must submit a paper return. Other restrictions may apply depending on                                the type of tax form you file.                                                                                                                                                                                                                                           
                                                                             eFile is a convenient and secure way for qualified taxpayers to file and pay Municipal Income Tax forms electronically. Currently CCA eFile allows the following:                                                                                                                                                                                                                



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           7.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          6. 5.                                                                                                                           4. 3.                                                                                  2. 1.                                                                                          The following types of income are exempt from municipal income tax (subject to ordinance). WHAT INCOME IS EXEMPT FROM THE TAX when it is received in retirement.                                                                                                    taxes are paid on income (salaries, wages, profits, and other compensation) when it is earned, not                                                                                                    are not deductible from wages. The cost of group term life plans over $50,000.00 are taxable. City                                                                                                Retirement Plans, i.e. 401(k), 403(b), IRA, Keogh, STRS, PERS “picked up” by a public employer taxable.                                                                                                     Short Term Disability benefits and third party sick pay received under a wage continuation plan are                                                                                                  Tuition grants which include research and/or teaching duties are subject to the city income tax. been made for listing on the tax return.                                                                                                  winnings (lottery subject to municipal ordinance) or any other income for which no provision has                                                                                                      (including retirement incentive plans, severance pay and short-term disability), prizes and gambling                                                                                                           commissions,  profit from  rents,  profit from  business,  professional  fees,  wage  continuation  plans         Taxable    WHAT INCOME IS TAXABLE               5.           4.                            3.                                                                                                                                                           2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               1.                                                                                   public assistance, etc.) if one or more of the following applies to you:                                                                                                   You must file a CCA Individual City Tax Form or Exemption Certificate (including retired persons, New Carlisle individuals 16 and 17 years old earning $2,500.00 or more are subject to the tax.                                                                                              on-the-Lake uses 15 as a minimum age. Grand River and West Milton use 16 as the minimum age. New Paris, Oakwood, Obetz, Phillipsburg, Riverside and Somerset have no minimum age; Geneva-                                                                                                        All individuals 18 years of age and older subject to local income tax. Note: Montpelier, Munroe Falls,                WHO MUST FILE  
commerce.  state or their political subdivisions to impose net income taxes on income derived from                                                                                               prohibited by the United States Constitution or any act of Congress limiting the power of the                                                                                               Salaries, wages, commissions and other compensation and net profits, the taxation of which is    estate during the period of administration (except income from the operation of a business).                                                                                                     by the State of Ohio and specifically excluded by statute from city tax, and income of a decedent’s                                                                                                   Gains from involuntary conversion, interest on federal obligations, items of income already taxed    Interest, dividends, royalties and other income specifically exempt (subject to ordinance). damages to property. Insurance      Alimony received. benefits received from any government agency.        Public          Pay or allowance of members of the armed forces or reserve components of the United States.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  exceeding     Own          Conduct           were        Have        performed outside the residence city (See Tax Rate Schedule).                                                                                    Live in a CCA member municipality with a tax credit of less than 100% when work is from filing.                                                                                             return for the year following the year in which they became permanently retired; are exempt                                                                                                  retired residents with no municipal taxable income; West Milton retired residents after filing a                                                                                             exempt income and have no tax liability to the Village of Obetz; New Carlisle and Riverside                                                                                              Note: Phillipsburg residents less than 16 years of age; Obetz residents whose only income is                                                                                      Live in a CCA member municipality that has mandatory filing. (See Tax Rate Schedule) 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            income                                          rental                         not         taxable
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 unemployment 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              not                               income                                       withheld    CCA
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            charge                                     which

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 annuities                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  gross 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            wages, 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           injuries                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    income
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         salaries, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 disability 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            rent 
           interstate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          taxes
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                                                                                 tips, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 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    not                                                                                   Sign and date your return before submitting it to the CCA – Division of Taxation. SIGNATURE       Form.                            submit payment with a copy                                    extension of time to                                                                                               confirmation  number  or  IRS  acknowledgment  to  the  City  Tax  Form  when  it  is  filed.     CCA        EXTENSION OF TIME TO FILE tax.                                                                                      Refunds or overpayments from a work city may affect the computation of the residence contact                                                                                     If you do not receive your refund within twelve (12) weeks after filing your return                                                                          requested information or the due date of the return, whichever is later.           taxpayer,                                                                                                               of                                                                                               Interest is paid on refunds issued 90 days after the complete return is filed or the due date                                www.ccatax.ci.cleveland.oh.us.      City      tax                                                                                         Those under 18 for all or part of the tax year may apply for a refund of the employment                           be notified by CCA of all                                                     amount to be refunded.                                          to                                                                               refunded. If                                                                  If          REFUND OR OVERPAYMENT                  not be remitted.                                                                                         Attach all methods of payment to the front of the tax form. Amounts $10.00 or less need  authorization.      with     be                                                                                         Checks or money orders should be made payable to CCA – Division of Taxation. There will METHOD OF PAYMENT Cleveland OH 44101-4810 PO BOX 94810                           CCA                       NO Payment Enclosed - Mail to: WHERE TO FILE paid when the return is filed.                                                                                        All wage earners must file on a calendar year basis. Total amount due as shown must be next succeeding day that is not a Saturday, Sunday or legal holiday.                                                                                                 falls on a Saturday, Sunday or legal holiday, a form is considered timely filed if filed on the                                                                                               Due date for the City Tax Form is April 15 following the close of the tax year. When April 15 WHEN TO FILE Assembly limiting the power of the City to impose net income taxes.                                                                                             which is prohibited by the Constitution of the State of Ohio or any act of the Ohio General    8. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        the  return,  whichever  is  later.                                                                                                                                                                                                                                         withheld in any CCA city (See paragraph 1 of “Who Must File” regarding exclusions). A                                                                                                                                                                                                                                                                       credit                                                                                                                                                         the                                                                                                                                                                                                                                                                               a $50.00 charge for dishonored checks. To charge the amount of tax due on line 18                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Salaries, wages, commissions, other compensation and net profits, the taxation of 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      – Division of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                honors                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         amount 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    this office.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Tax                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Visa, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                all 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                90                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              a                                                                                                                                                              of 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                IRS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             day                                                                                                                                                                                                                                                                                                                                                                                       Refund                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Card, 
                                                                                                                                                                                                                                                                                           ile does not extend the time to pay the tax due.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  overpayments.                                                                 Credit and refund amounts must be greater than $10.00. IRS must 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                extension.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      period                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          of 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Discover                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                             of the IRS extension by the original due date of the City Tax 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Worksheet                                                                                                                                                                                                                                                                                                                                                             the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Cleveland OH 44101-4723 PO BOX 94723                           CCA – Division of Taxation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Payment Enclosed - Mail to:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                for                                                           If  we  must  request  additional  information  from  the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         overpayment                                                                                                                                                    is 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               $10.00 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Attach 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                issuance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                or 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        American 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                a 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                copy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      required                                                                                                                                                                                                                                                                                                                                                              to                                                                                                                                                             less, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                begins 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                their 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                of 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                2024                                                                                                                                                           amount 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             when                                                                                                                                                                                                                                                                                                                                                                                      and 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Cleveland OH 44101-4520 PO BOX 94520                           CCA – Division of Taxation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                IRS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             tax                                                                                                                                                                                                                                                                                                                                                                                                                                     complete 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                we                                                                                                                                                                                                                                                                                                                                                                                        may 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                extension, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                have                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           not 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          be 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        the 
                                                                                                                                                                                                                                                                                                                                            If tax is due,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      or                                                                                                                                                             be 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                received                                                                                                                                                                                                                                                                                                                                                                                  obtained 
            A return is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         request                                                                                                                                                        credited                                                                                                                                                                                                                                                                 credit 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                extension 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        card 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                the 
                                                                                                                                                                                                                                                                                                                                                           An                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   all                                                                                                                                                                                                                                                                                                                                                                                       at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   or 



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AVOID COMMON MISTAKES claimed return, If husband and wife made joint estimates during the year and are now filing a separate ccatax.ci.cleveland.oh.us or by calling 216-664-2070, option 2. Estimated ESTIMATED TAX PAYMENTS offense. with penalties of up to $1,000.00 fine and up to six months imprisonment for each Criminal penalties for failure to comply with the income tax ordinance are provided PENALTY AND INTEREST RATES Spouse” and agent should sign as “Personal Representative.” “DECEASED”  in the space provided for the signature. Spouse should sign as “Surviving the person. The person who files the return should write “DECEASED” and the date of death in taxpayer’s spouse  or  personal  representative  may  have  to  file and  sign  a  return  for  the DECEASED may elect to authorize your preparer to contact CCA regarding this return (ORC 718.05). the authorized to sign for such taxpayer. “filed” within the meaning of the law, until signed by the taxpayer or an agent legally 

Make the check or money order payable to CCA – Division of Taxation. remittance on top of the wage statements attached to the front of the return. credit card authorization and attach it to the front of the tax form. Write your Taxpayer Identification Number on your check, money order or return Attach all schedules and Wage and Tax Statements (Forms W-2) to the tax If a refund is requested, highlight the box on line 11b and/or 16b. Attach the employer has shown “Various,” “Multiple,” etc., as the name of locality on It is important that we know the exact cities you live and work in. If your Employment Tax withheld cannot be used as Residence Tax. State tax withheld. See specific municipal ordinance. Be sure to use “Local income tax” withheld. Do not use School District tax or your Wage and Tax Statements (Forms W-2). Use the Medicare wage in box 5, which is usually the highest figure shown on Write your Social Security Number on your return. name taxpayer, this person should also sign the return. By checking the appropriate box you 
Failure to file timely may incur a penalty of $25.00. paid and a monthly interest charge. Failure to pay tax when due may incur a 15% penalty of the amount not timely tax in accordance with ORC section 718.08. year may result in penalty and interest charges for underpayment of estimated or 100% of the prior year tax due no later than 15 days after the end of your tax Failure to pay estimated tax payments totaling 90% of the current year tax due municipal ordinance. ORC 718 Penalty and interest rates are available on our website. See specific CCA member municipalities follow the penalty and interest rates indicated in 
Form by each social security number. attach 
 payments and 
before mailing. the TAXPAYERS 

detail listing provided by your employer to the return. W-2, a address 
brief 
be and
statement 
sure portion 
prior
If 
to the 
year
list to taxpayer 
of 

exactly your credits the 
tax If the return is prepared by someone other than 
return, 
may
which return. expired 

signed be
cities reviewed When before 

by 
you signing filing 
both, 24/7
have
indicating online a 
the return 
worked
tax 
 Place the at
https://efile. for 
the return, 
in. 2023, 
 
amount 
 
write 
  the 



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                            CITY TAX FORM                          WR ¿OH WKH &LW\ 7D[ )RUP STOP                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       EXEMPTION CERTIFICATE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Live in a non CCA municipality                                                                                            Live in a CCA municipality                                                                                  Live in a CCA municipality                                                                                           Live in a CCA municipality                                                                                                                                      Live in a CCA municipality                                                                                                                        PREPARING YOUR TAX RETURN
Enter your city of residence and phone number. Write your Social Security Number on your return. sure to enter the date of change. the year, show both your current and your old address in the spaces provided. Be                                                             Print or type your name and address in the spaces provided. Filing Status – Check the appropriate box. electronic      Extension – Check the box and attach a copy of Federal Extension Form 4868 or                                                                                                                                                    Keep the top portion for your records.                                                                                   'HWDFK DQG PDLO WKH FRPSOHWHG ERWWRP SRUWLRQ RI ([HPSWLRQ &HUWL¿FDWH WR WKLV RႈFH                                                                     6LJQ WKH ([HPSWLRQ &HUWL¿FDWH  HQWHU \RXU SKRQH QXPEHU DQG WKH GDWH    January 1, 202 If you ceased doing business or sold your rental property in a CCA community prior to check the appropriate Box 1 through 4.                                                                                     )RU WKRVH ZKR OLYH LQ D PDQGDWRU\ ¿OLQJ FRPPXQLW\ DQG DUH H[HPSW IURP SD\LQJ WD[HV    Write your Social Security Number on the form. to enter the date of change. the year, show both your current and your old address in the spaces provided. Be sure                                                                                     Print or type your name and address in the spaces provided. If you have moved during
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      ²,I \RX TXDOLI\ DQG KDYH FRPSOHWHG WKH ([HPSWLRQ &HUWL¿FDWH  \RX DUH QRW UHTXLUHG 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               IF YOU
                                                                                                                                                                                                                                                                                                                                                                                       acknowledgement.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               check Box 5.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    not                               municipality AND city tax was                              work or earn income in a CCA not                               municipality AND city tax was                              work or earn income in a CCA from which you live                                 ZRUN LQ D GLႇHUHQW PXQLFLSDOLW\               withheld                               municipality AND city tax was                      work in the same CCA municipal purposes.                                   and dividends are not taxable for                                    Pension, social security, interest                         have no taxable income. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     withheld                                                                                                                        withheld

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                                                                                                                                                                                                                    If you moved during                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              THEN COMPLETE 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        sections A, B, B-1
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              sections A, A-1                                        City Tax Form                                                           sections A, A-1,                                 City Tax Form                                                                                                                                 City Tax Form                                                                      City Tax Form
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   section A                                                                                                                 &HUWL¿FDWH                                                                                                                                Exemption                                       AND FILE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              B, B-1




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and the CCA Resident Business/Rental municipalities with current and/or prior year losses see CCA rules and Regulations Article 11 municipalities forward rental Business  or  rental  income  may  be  decreased  by  business  or  rental  losses.  Business  and ordinance). back of the return. Losses may be carried forward for five (5) years (subject to municipal Losses from either business or rental property must be documented on Schedule L, on the Business, Rental and Other Income and Losses raffles, Line 6 – Name the city and enter any other income received from estates and trusts, Line 5 – Name the city and enter income from Partnerships, Sub Chapter S Corporations your Federal Schedule E. Line 4 – Name the city and enter only the rental profit from Schedule E. Attach a copy of one municipality. Attach a copy of the Federal Schedules and a breakdown if income was earned in  more than  Line 3 – Name contacting our office. income. Resident municipalities NOTE: CCA residents that have net profit/distributive share income sourced in multiple Line 2 - 6. Line 1. Tips not reported to your employer should be treated as miscellaneous income on Line highest wage figure. deferred  compensation  is  taxable,  use  medicare  wage  in  box  5,  which  usually  is  the Enter income supplemental Report shown on Wage and Tax Statements (Forms W-2). as Line 1 - down and combined by city in Section A, Employment / Profit Tax. attach a separate schedule. Each item of income that you list in this section must be brought List all of your income by source on Lines 1 through 6. If additional space is needed, please  LINE INSTRUCTIONS
 
losses may not be deducted directly from wages. If a loss is realized, the loss is carried   your 
by another even if both entities are within the same municipality. as an individual. their CCA Schedule residence Partnerships, and Enter total taxable wage income. regardless the Enter the employer’s name, city where work was performed and the local wages 
The Business/Rental 
the taxable 
contests, and other miscellaneous income reported on Form 1099. distributive 120-17). Trusts. pay, full 
with partnership the worksheet with 
amount 
C, municipal city wages of sick 
net 
must  Estates Attach current  Tips reported to your employer are treated as wages and reported on whether 
Individuals and pay, 
profit A loss from one entity may not be used to offset a gain from share
file Income 
to ordinance) copies may by of 
enter employer short your 
offset income.  and and and/or municipal 
and/or 
 may be 
pay Trusts, of only term wages, 
any obtained Worksheet 
Income Worksheet. take Federal prior as income disability 
distributive Each entity’s gain or loss is taxed separately to you tax and the 
possible Sub shown 
credit as Limited net salaries, 
at 
entities Chapter Schedules year 
profit in tax 
future for www.ccatax.ci.cleveland.oh.us on pay, 
lieu losses has 
share Liability Forms bonuses, 
taxes
using from excess 
S
gains. E of been 
Corporations
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Net withheld reimbursements 
Residents by II tips, 
Profit 3,4,5 For 
sourced these and complete 
C city fees, 
Annual not (subject K-1. and by 
or 
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of tax commissions, 
in CCA filing Schedule 6 
(Form to business the purposes employer. and 
multiple on on or 
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CCA other 
a 
F. by 
 



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If you fail to complete the estimate, CCA will not automatically bill you.                                                             the current tax year. If you fail to complete the estimate,                                                                                          Estimates may be amended if a significant increase or decrease in income occurred during tax due for 2023.                                                                                            liability. If you do not know what you will owe in 2024, base your estimate on 100% of the                                                                                           payments totaling at least 90% of the current tax year liability or 100% of the prior tax                                                                                       You may be charged penalty and interest if you fail to timely pay quarterly estimated ordinance).                                                                                     and credits), you must file an Employment/Profit Tax Estimate (subject to municipal                                                                                         $200.00 or more in employment tax in 2024 (after subtracting your estimated withholding                                                                                     If there was employment tax due to a CCA municipality in 2023 and you expect to owe                                      return and requesting a refund for that overpayment.                                                                                      Call the city hall of the NON-CCA municipality to obtain information on filing a tax                                                                                      municipality. CCA member municipalities are listed on the reverse of the tax return.       NOTE:                                                                                                                                                                                                                                                 Line 11 –   CCA municipality to obtain information on filing a tax return and paying tax due. municipalities are listed on the reverse of the tax return. Call the city hall of the NON-       NOTE:                 Line 10 –                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Column 8 – If the Tax Due is $10.00 or less enter zero. If the Tax Due is positive and greater                                                                                      Column 7 – Enter the amount of employment tax estimate payments that were applied to Column 6 – Enter the amount of overpayment from 2022 that you applied toward 2023. the return, attach your Forms W-2, and file the return with CCA.                                                                                       STOP – If all of your wages were earned in the same city in which you lived, and city                                                                                                                                                                                                   Column 5 –                                                                                                Column 4 –                                                                   Column 3 – Enter the work city tax rate.                                                                                          Column 2 –                                                                                                                                                                    Column 1 –                                                                                  to keep the tax due, the credits or the amounts withheld separate for each city.                                                                                             sources (Line 6). Combine your income by city and list each only once in Section A. Be sure                                                                                            you have received from business (Line 3), rental property (Line 4), K-1 (Line 5) and other                                                                                             Use this section to calculate the tax that you owe on your wages (Line 2) and on the income                                          SECTION A - EMPLOYMENT / PROFIT TAX 202
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         SECTION A-1 – EMPLOYMENT / PROFIT TAX

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           tax was correctly withheld, complete only the yellow sections. Sign and date  
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Tax                                                                                                                                                                                                                                                                                                                                                                                                                                                  Tax 
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Add all the positive amounts in Column 8 to arrive at the total employment tax                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Enter      Rate in Column 3.                                                                              To calculate the Tax Due, multiply the Taxable Income in Column 2 by the Tax                                          only once.                                                                               Combine and enter the taxable income for each city. List income for each city each city only once.                                                                            List the name of each city where work was performed or income earned. List 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             overpaid   as a refund. The credit or refund amount must be greater than $10.00 per city.                                                                             overpayment. Enter the amount you want to credit towards next year or claim     Add                                                                                                                                                                                            due                                                                                                  subtracted from the Tax Due to another city.                                                                           Enter the amount of the overpayment on line 11. The overpayment cannot be                                                               Overpayments greater than $10.00 may be credited or refunded.                                                                              than $10.00, then this is the amount of employment tax you owe to each city.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          partnership or Sub Chapter S Corporation.                                                                             amount of tax that you have paid directly to a NON-CCA city or tax paid by a

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   the                                                                                                                                                                                            to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     the

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   negative                                                                                                                                                                                       a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      tax
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             to                                                                                                                                                                                                                                                                                                                                                                                                                                                   NON-CCA 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           that
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             NON-CCA 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   amounts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               has

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  city                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   been

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             city                                                                                                                                                                                                                                                  in                                                                                                                                                                                             cannot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 withheld
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   column 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             cannot 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  be 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         for
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   8                                                                                                                                                                                              paid 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             be                                                                                                                                                                                                                                                    to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    each
                                                                           CCA will not automatically bill you.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         ESTIMATE - 2024                                                                                                                                                                                                                                                                                                                                                                                                                                     used                                                                                                                                                                                                                                                  arrive                                                                                                                                                                                         on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         city
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  this 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             to                                                                                                                                                                                                                                                    at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    by
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             offset tax                                                                                                                                                                                                                                            the                                                                                                                                                                                            return.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                your

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   total                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 employer
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  CCA 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             due                                                                                                                                                                                                                                                   amount 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  member                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 or
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             a 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              the
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    



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Column 17 – Column 16 – Column 15 – Column 14 – Section B – Residence Tax 2023 Column 5 – Column 4 – Column 3 – Column 2 – Column 1 – REWDLQHG IURP ZZZ FFDWD[ FL FOHYHODQG RK XV RU E\ FRQWDFWLQJ RXU RႈFH losses should complete the CCA Resident Business/Rental Income Worksheet which may be or distributive share income sourced in multiple municipalities with current and/or prior year IURP WKH ZRUNVKHHW RQ 6FKHGXOH 5  5HVLGHQWV RI &&$ PXQLFLSDOLWLHV WKDW KDYH QHW SUR¿W DQG NOTE: If you use the CCA Resident Business/Rental Income Worksheet do not include income Schedule R Worksheet the Schedule R Worksheet, return to Section B – Residence Tax – 202 Section A and should not be confused with taxes paid to employment cities. to calculate the tax that is owed to your residence city. 6FKHGXOH 5 RQ WKH UHYHUVH RI WKH WD[ UHWXUQ  7KH 6FKHGXOH Residence  SECTION B – RESIDENCE TAX – 202
Line 13 -  quarter. You may pay the balance due at this time or in quarterly installments. amount Column 13 – This Column 12 – Column 11 – Column 10 – Column   9 – 

amount 
 is the first quarter installment. If the amount is zero or less, no payment is due this 
tax     
Enter
employment tax withheld. tax Enter Enter the total tax due for each residence city. (Schedule R, Col. 5) Enter the total of taxable income for each residence city. (Schedule R, Col. 2) List the name of each city where you lived during 2023. 2023 on the front of the tax return. total Multiply (c) (b) (a) To locate your adjusted residence tax rate: Enter by the number of months that you lived in each of the cities. twelve (12). This will approximate your monthly income. Multiply your monthly income each residence city. To prorate your income, take your total income and divide it by income, the income will need to be prorated to show the amount earned while living on the front of the tax return. If you lived in more than one city while you earned this should be the same as the total of Column 15 in Section B – Residence Tax 2023 city in which you live. Worksheet. There is no additional residence tax due for income earned in the same city Enter name of work city. If more than one city, list each city separately. If work Total all Columns. Divide the amount in Column 10 by four (4) and subtract Column 11. This reflects Subtract List any overpayment from line 11a which you want credited to 2024 tax. tax rates. Estimate income for these cities and calculate the tax due. Be sure to use 2024 List employment cities where you expect to owe tax. 
may
Circle that percentage and enter in Column 4 of the Schedule R Worksheet residence city Follow that WORK CITY column down until you reach the row naming your municipality. rate of a non-CCA municipality you can ask your employer or the city hall of that Find the WORK CITY RATE in the shaded area of SCHEDULE R.  To find the tax
withheld 
the of name total is be
Column Column the
Residence of income due the Column
same
the on balance 
is 
5 2 income
a should by city earned 11
as
separate 
residence
Tax Column that of from
earned
Withheld be you in estimated 
each Column
withholding entered 4 lived
and city, outside
city 3
by in employment 
while listed
your in enter enter This tax is in addition to any tax paid in 10
Column16 your and
and the you city
employer in 5 UHÀHFWV CCA residence
name
tax earned Column enter
should tax 
due
Section that
on 3 due 
(Forms your the 1. . WKH 
not 
for 
income The line DGMXVWHG amount
be B residence ** city. 2024.
W-2). total
Residence of
confused in After completing First in
of the
Residence Column WD[ Column
Column Schedule refer
city. UDWH 
  
with Tax The 2. XVHG  to 12.
 2 the
in R  



- 10 -

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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Line 18 –                                                                                      Line 17 –                                                                                                                                                                                                                 Column 25 – Divide                                                                      Column 24 – Subtract Column 23 from Column 22 and enter that amount in Column 24. This Column 23 – List any overpayment from Line 16a which you want credited to 2024 tax.                                                                                             Column 22 – Estimate income and tax due for your residence city. Calculate the tax due just Column 21 – List the residence city.                                       If you fail to complete the estimate,                   current tax year.                                                                                          Estimates may be amended if a significant increase or decrease in income occurred during                                                                                     know what you will owe in 2024, base your estimate on 100% of the tax due for 2023.                                                                                                     totaling at least 90% of the current tax year liability or 100% of the prior tax liability.  If you                                                                                                You may be charged penalty and interest if you fail to timely pay quarterly estimated payments Tax  Estimate (Subject to municipal ordinance).    in                                                                                           If there was residence tax due in 2023 and you expect to owe $200.00 or more in residence                                                                                                                                                                                                                       Line 16 –                                                                       Line 15 –                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Column 20 – If the Tax Due amount is $10.00 or less enter zero. If the Tax Due is positive      Column 19 – Enter                                                                                    Column 18 – Enter the amount of overpayment from 2022 that you applied toward 2023.
                                                                                                                                                                                                                                                                                                                                                                                                                                                  MAILING YOUR RETURN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    SECTION B-1 - RESIDENCE TAX ESTIMATE – 202
Keep a copy for your records. Sign, date and mail your return by the due date. Place remittance on top of tax statements. write your taxpayer identification number on your remittance. Attach a check, money order or credit card authorization to the front of the form. Be Attach all Wage and Tax Statements (Forms W-2) and all schedules to the tax return. Check your calculations. Verify your (9) nine digit social security number(s).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                2024 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (after 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Add amounts shown in the last column of lines 10, 13,15 and 17 for the total                   Total all columns.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      amount you must remit to CCA.                                                                                                                  quarterly installments.                                                                              payment is due this quarter. You may pay the balance due at this time or  in        amount                            amount reflects the balance of estimated residence tax due for 2024.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               refund.                                                                                  overpayment. Enter the amount you want to credit towards next year or claim as a Add the negative amounts in Column 20 to arrive at the total amount of you owe. Add the positive amounts in Column 20 to arrive at the total residence tax that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                subtracting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  subtracted from the Tax Due to another city.                                                                           Enter the amount of the overpayment on Line 16. The overpayment cannot be                                                               Overpayments greater than $10.00 may be credited or refunded.                                                                             and greater than $10.00, then this is the amount of residence tax you owe.                                                                                             2023.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             the                                                                                                                                                                                                                                                                as you did in Section B. Be sure to use 2024 tax rates.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            The credit or refund amount must be greater than $10.00 per city.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              the
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              is 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             amount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               amount
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                your 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              first 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 estimated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              quarter        Column                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          CCA will not automatically bill you.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 residence

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              installment.   22                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 withholding 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  tax
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             by
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  estimate
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             four

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              If             (4)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                and 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              the            and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  payments
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                credits), you 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              amount         subtract
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              or             23.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                file a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            applied
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      the                                                                                                                                                                                                                                                                                                                                                                  do not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             tax 



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limited to one percent when work is outside residence city.                                             **                                                                                                       *
                                                                                                         Residence credits are limited to 75% of the City/Village tax rate when work is outside residence city. Residence credits are limited to one half of one percent when work is outside residence city. West Milton Waynesfield Union South Russell Somerset Shreve Seville Russells Point Rock Creek Riverside Pitsburg Phillipsburg Paulding Orwell Obetz         Oakwood                  North Randall North Baltimore New Paris New Miami New Madison New Carlisle Munroe Falls Montpelier Mentor-on-the-Lake Marble Cliff Linndale Highland Hills Grand River Grand Rapids Germantown Geneva-on-the-Lake Elida Edon  Dalton Cleveland Clayton Burton               MUNICIPALITY

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (Paulding County)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          FILE                       MUST

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           WORK                          CCA MEMBER MUNICIPALITIES
                                                                                                                                                                                                                                                                                                              1.5%                    1.5%  1.25%                                                           2.5%               1.5%         1.1%     1.5%   2.5%                                   2.75%                                   1.75%                 1.5%         2.25%        1.6%                                                2.5%                                    1.5%       1.5%               .75%  1.75%        2.5%      1.5%              RATE                                                                          TAX RATE SCHEDULE
                                                                                                                                                                                                                                                                                                                          1%                              1%       1%     1%      1%             1%                   1%                                                  1%                                     1%              1%                  1%                                               2%                 2%           2%                      2%          1%                                                     1%                       1%

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           RESIDENCE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    CREDIT
                                                                                                                                                                                                                                                                                                                          100%        100%                                                       100%       100%                                     100%   100%          100%                     100%                                    100%      100%                     100%         100%       100%               100%         100%     100%           100%        50%          60%                                 100%  100%   100%      50%     50%                                            2023
                                                                                                                                                                                                                                                                                                              0%                            **            0%              0%      0%                                  0%       ***          0%                                                                   0%                                              0%                                                                                                                               ***                0%
                                                                                                                                                                                                                                                                                                                                                                   *                                                                                                                                                             *

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           CREDIT
                                                                                                                                                                                                                                                                                                                                      1.5%  .94%                   .50%                                     2.5%                                     1.5%   2.5%                                   2.75%                         .50%      1.75%                              2.25%        1.6                                                 2.5%                       .50%         .90%                                1.75%        2.5%      .75%    .50%      LIMIT
                                                                                                                                                                                                                                                                                                              0%          1%                              0%              0%      0%             1%                   0%       1%           0%                            1%                                     0%                                  1%          0%                        %          2%                 2%           2%                      2%                                  1%                 0%          1%

                                                                                                        ***                                                                                                                                                                                                   1.5%                    1.5%  1.25%                                                           2.5%               1.5%         1.1%     1.5%   2.5%                                   2.75%                                   1.75%                 1.5%         2.25%        1.6%                                                2.5%                                    1.5%       1.5%               .75%  1.75% 1.5%   2.5%      1.5%              RATE                   WORK
                                                                                                                                                                                                                                                                                                                          1%                              1%       1%     1%      1%             1%                   1%                                                  1%                                     1%              1%                  1%                                               2%                 2%           2%                      2%          1%                                                                              1%
                                                                                                        Residence credits are 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           RESIDENCE     2024
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    CREDIT
                                                                                                                                                                                                                                                                                                                          100%        100%                                                       100%       100%                                     100%   100%          100%                     100%                                    100%      100%                     100%         100%       100%               100%         100%     100%           100%        50%          60%                                 100%  100%   100%      50%     50%
                                                                                                                                                                                                                                                                                                              0%                            **            0%              0%      0%                                  0%       ***          0%                                                                   0%                                              0%                                                                                                                               ***                0%
                                                                                                                                                                                                                                                                                                                                                                   *                                                                                                                                                             *






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