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MUNICIPAL INCOME TAX

                               202
                                          2

                           INDIVIDUAL

                           TAX FORM

            INSTRUCTION BOOKLET

            CCA – DIVISION OF TAXATION

7KLV SDFNHW LQFOXGHV D    2 &LW\ 7D[ IRUP  ([HPSWLRQ &HUWL¿FDWH  LQVWUXFWLRQV DQG  a 
return envelope.

The 202 2Return is due April 18, 2023.

For the tax year 2022, 90% of the tax due must be paid by January 15, 2023to avoid 
penalty and interest (subject to municipal ordinance).

Estimated payments and prior year credits may be reviewed 24/7 online at https:// 
H¿OH FFDWD[ FL FOHYHODQG RK XV 

Attach your remittance to the front of the form. Make checks payable to
CCA – Division Of Taxation.

Additional information may be obtained at www.ccatax.ci.cleveland.oh.us



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                         CCA eFile

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their CCA Municipal Income Tax forms electronically.

Currently CCA eFile allows the following:

     ,QGLYLGXDO2([HPSWLRQ &HUWL¿FDWH 

  Use this electronic form if you had no earned income for the entire 

  year.

202 2Individual Annual City Tax Form

Individual Estimated Payment

Tax, Penalty and/or Interest Payment

Review account estimate and credit information 
  ,I \RX KDYH DQ\ RI WKH IROORZLQJ  \RX FDQQRW XVH H)LOH WR ¿OH DQ ,QGLYLGXDO 
  City  Tax Form at this time.  You must submit a paper return. Other 
  UHVWULFWLRQV PD\ DSSO\ GHSHQGLQJ RQ WKH W\SH RI WD[ IRUP \RX ¿OH 

     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

                  Visit our web site for details

        www.ccatax.ci.cleveland.oh.us 



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WHO MUST FILE  
All individuals 18 years of age and older subject to local income tax. Note: Montpelier, Munroe Falls, 
New Paris, Oakwood, Obetz, Phillipsburg and Riverside have no minimum age; Geneva-on-the-Lake 
uses 15 as a minimum age. Grand River and West Milton use 16 as the minimum age. New Carlisle 
individuals 16 and 17 years old earning $2,500.00 or more are subject to the tax.
You must file a CCA Individual City Tax Form or Exemption Certificate (including retired persons, public 
assistance, etc.) if one or more of the following applies to you:
1. Live in a CCA member municipality that has mandatory filing. (See Tax Rate Schedule) 
   Note: Phillipsburg residents less than 16 years of age; Obetz residents whose only income is 
   exempt income and have no tax liability to the Village of Obetz; New Carlisle and Riverside 
   retired residents with no municipal taxable income; West Milton retired residents after filing a 
   return for the year following the year in which they became permanently retired; are exempt 
   from filing.
2. Live in a CCA member municipality with a tax credit of less than 100% when work is performed 
   outside the residence city (See Tax Rate Schedule).
3. Have taxable income in a CCA member municipality in which municipal income taxes were not 
   withheld or were withheld incorrectly.
4. Conduct business in a CCA member municipality.
5. Own rental property in a CCA member municipality and charge gross monthly rent
   exceeding $125.00 (Rental income subject to municipal ordinance). 

WHAT INCOME IS TAXABLE
Taxable income includes but is not limited to, the following: Income from wages, salaries, tips, 
commissions, profit from rents, profit from business, professional fees, wage continuation plans 
(including retirement incentive plans, severance pay and short-term disability), prizes and gambling 
winnings (lottery subject to municipal ordinance) or any other income for which no provision has 
been made for listing on the tax return.

Tuition grants which include research and/or teaching duties are subject to the city income tax. 
Short Term Disability benefits and third party sick pay received under a wage continuation plan are 
taxable.

Retirement Plans, i.e. 401(k), 403(b), IRA, Keogh, STRS, PERS “picked up” by a public employer 
are not deductible from wages. The cost of group term life plans over $50,000.00 are taxable. City 
taxes are paid on income (salaries, wages, profits, and other compensation) when it is earned, not 
when it is received in retirement.

WHAT INCOME IS EXEMPT FROM THE TAX 
The following types of income are exempt from municipal income tax (subject to ordinance).
1. Pay or allowance of members of the armed forces of the United States.
2. 3XEOLF  DVVLVWDQFH   XQHPSOR\PHQW  FRPSHQVDWLRQ  EHQH¿WV   SHQVLRQV   DQQXLWLHV  RU  GLVDELOLW\
   EHQH¿WV UHFHLYHG IURP DQ\ JRYHUQPHQW DJHQF\ 
3. Alimony received.
4. Insurance proceeds received for reason of death, compensatory personal injuries or for
   damages to property.
5. ,QWHUHVW  GLYLGHQGV  UR\DOWLHV DQG RWKHU LQFRPH VSHFL¿FDOO\ H[HPSW   VXEMHFW WR RUGLQDQFH 
6. Gains from involuntary conversion, interest on federal obligations, items of income already taxed
   E\ WKH 6WDWH RI 2KLR DQG VSHFL¿FDOO\ H[FOXGHG E\ VWDWXWH IURP FLW\ WD[  DQG LQFRPH RI D GHFHGHQW¶V 
   estate during the period of administration (except income from the operation of a business).
7. 6DODULHV  ZDJHV  FRPPLVVLRQV DQG RWKHU FRPSHQVDWLRQ DQG QHW SUR¿WV  WKH WD[DWLRQ RI ZKLFK   
   is prohibited by the United States Constitution or any act of Congress limiting the power of the
   state or their political subdivisions to impose net income taxes on income derived from
   interstate commerce.

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     6DODULHV  ZDJHV  FRPPLVVLRQV  RWKHU FRPSHQVDWLRQ DQG QHW SUR¿WV  WKH WD[DWLRQ RI ZKLFK 
 is prohibited by the Constitution of the State of Ohio or any act of the Ohio General Assembly 
 limiting the power of the City to impose net income taxes.

 WHEN TO FILE
 Due date for the City Tax Form is April 15 following the close of the tax year. When April 15 
 IDOOV RQ D 6DWXUGD\  6XQGD\ RU OHJDO KROLGD\  D IRUP LV FRQVLGHUHG WLPHO\ ¿OHG LI ¿OHG RQ WKH QH[W 
 succeeding day that is not a Saturday, Sunday or legal holiday.
 $OO ZDJH HDUQHUV PXVW ¿OH RQ D FDOHQGDU \HDU EDVLV  7RWDO DPRXQW GXH DV VKRZQ PXVW EH SDLG 
 ZKHQ WKH UHWXUQ LV ¿OHG 

 WHERE TO FILE
 NO Payment Enclosed - Mail to: Payment Enclosed - Mail to:     Refund Request - Mail to: 
 CCA – Division of Taxation     CCA – Division of Taxation  CCA – Division of Taxation
 PO BOX 94810                   PO BOX 94723                PO BOX 94520
 Cleveland OH 44101-4810        Cleveland OH 44101-4723     Cleveland OH 44101-4520

 METHOD OF PAYMENT
 Checks or money orders should be made payable to CCA – Division of Taxation. There will be 
 a $50.00 charge for dishonored checks. To charge the amount of tax due on line 18 with Visa, 
 Master Card, Discover or American Express, complete the credit card authorization. 
 Attach all methods of payment to the    front of the tax form. Amounts $10.00 or less need not 
 be remitted.

 REFUND OR OVERPAYMENT
 If the amount of overpayment is $10.00 or less, the amount will not be credited or refunded. If 
 the amount of overpayment is greater than $10.00, the taxpayer has the option to credit all or 
 a portion of the overpayment to their 2023 tax liability or request the amount to be refunded. 
 Credit and refund amounts must be greater than $10.00. IRS must be notified by CCA of all 
 overpayments.

 Those under 18 for all or part of the tax year may apply for a refund of the employment tax 
 withheld in any CCA city (See paragraph 1 of “Who Must File” regarding exclusions). A City 
 Tax Form Refund Worksheet is required and may be obtained at 
 www.ccatax.ci.cleveland.oh.us. 

 Interest is paid on refunds issued 90 days after the complete return is filed or the due date of 
 the return, whichever is later. If we must request additional information from the taxpayer, the 
 90 day period for issuance begins when we have received all requested information or the due 
 date of the return, whichever is later. 

 If you do not receive your refund within twelve (12) weeks after filing your return contact this 
 office.

 Refunds or overpayments from a work city may affect the computation of the residence tax.

 EXTENSION OF TIME TO FILE
 &&$  KRQRUV WKH ,56 H[WHQVLRQ  $WWDFK  D  FRS\  RI  WKH ,56  H[WHQVLRQ  H[WHQVLRQ FRQ¿UPDWLRQ  
 QXPEHU RU ,56 DFNQRZOHGJPHQW WR WKH &LW\ 7D[ )RUP ZKHQ LW LV ¿OHG  An extension of time to 
 ¿OH GRHV QRW H[WHQG WKH WLPH WR SD\ WKH WD[ GXH  If tax is due, submit payment with a copy 
 of the IRS extension by the original due date of the City Tax Form. 

 SIGNATURE
 Sign and date your return before submitting it to the CCA – Division of Taxation. A return is not 
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³¿OHG´ ZLWKLQ WKH PHDQLQJ RI WKH ODZ  XQWLO VLJQHG E\ WKH WD[SD\HU RU DQ DJHQW OHJDOO\ 
authorized to sign for such taxpayer. If the return is prepared by someone other than the 
taxpayer, this person should also sign the return. By checking the appropriate box you may 
elect to authorize your preparer to contact CCA regarding this return (ORC 718.05).
DECEASED TAXPAYERS ,I WKH WD[SD\HU H[SLUHG EHIRUH ¿OLQJ D UHWXUQ IRU       WKH WD[SD\HU¶V 
VSRXVH RU SHUVRQDO UHSUHVHQWDWLYH PD\ KDYH WR ¿OH DQG VLJQ D UHWXUQ IRU WKH SHUVRQ  7KH 
SHUVRQ ZKR ¿OHV WKH UHWXUQ VKRXOG ZULWH ³'(&($6('´ DQG WKH GDWH RI GHDWK LQ WKH QDPH 
and address portion of the tax return. When signing the tax return, write “DECEASED” in 
the space provided for the signature. Spouse should sign as “Surviving Spouse” and agent 
should sign as “Personal Representative.”

PENALTY AND INTEREST RATES
CCA member municipalities follow the penalty and interest rates indicated in ORC
       3HQDOW\ DQG LQWHUHVW UDWHV DUH DYDLODEOH RQ RXU ZHEVLWH  6HH VSHFL¿F PXQLFLSDO 
  ordinance.
Failure to pay estimated tax payments totaling 90% of the current year tax due or
  100% of the prior year tax due no later than 15 days after the end of your tax year
  may result in penalty and interest charges for underpayment of estimated tax in
  accordance with ORC section 718.08.
Failure to pay tax when due may incur a 15% penalty of the amount not timely paid
  and a monthly interest charge.
)DLOXUH WR ¿OH WLPHO\ PD\ LQFXU D SHQDOW\ RI        SHU PRQWK 
Criminal penalties for failure to comply with the income tax ordinance are provided
ZLWK SHQDOWLHV RI XS WR           ¿QH DQG XS WR VL[ PRQWKV LPSULVRQPHQW IRU HDFK 
RႇHQVH 

ESTIMATED TAX PAYMENTS
Estimated payments and prior year credits may be reviewed 24/7 online at KWWSV   HÀOH 
FFDWD[ FL FOHYHODQG RK XV.
,I KXVEDQG DQG ZLIH PDGH MRLQW HVWLPDWHV GXULQJ WKH \HDU DQG DUH QRZ ¿OLQJ D VHSDUDWH 
return, attach a brief statement to your return, signed by both, indicating the amount claimed 
by each social security number.

AVOID COMMON MISTAKES

Write your Social Security Number on your return.
8VH WKH 0HGLFDUH ZDJH LQ ER[    ZKLFK LV XVXDOO\ WKH KLJKHVW ¿JXUH VKRZQ RQ  
  your Wage and Tax Statements (Forms W-2).
%H VXUH WR XVH ³/RFDO LQFRPH WD[´ ZLWKKHOG  'R QRW XVH 6FKRRO 'LVWULFW WD[ RU  
  6WDWH WD[ ZLWKKHOG  6HH VSHFL¿F PXQLFLSDO RUGLQDQFH 
Employment Tax withheld cannot be used as Residence Tax.
It is important that we know the exact cities you live and work in. If your
  HPSOR\HU KDV VKRZQ ³9DULRXV ´ ³0XOWLSOH ´ HWF   DV WKH QDPH RI ORFDOLW\                      RQ WKH 
  Form W-2, be sure to list exactly which cities you have worked in. Attach the 
  detail listing provided by your employer to the return.
If a refund is requested, highlight the box on line 11 and/or 16.
Attach all schedules and Wage and Tax Statements (Forms W-2) to the tax return
  before mailing.
:ULWH \RXU 7D[SD\HU ,GHQWL¿FDWLRQ 1XPEHU RQ \RXU FKHFN  PRQH\ RUGHU RU    
  credit card authorization and attach it to the front of the tax form. Place the
  remittance on top of the wage statements attached to the front of the return.
Make the check or money order payable to CCA – Division of Taxation.
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 PREPARING YOUR TAX RETURN

           IF YOU                            AND                   THEN COMPLETE 
                                                                   AND FILE

                                have no taxable income. 
                                Pension, social security, interest Exemption
 Live in a CCA municipality
                                and dividends are not taxable for  &HUWL¿FDWH
                                municipal purposes.
                                work in the same CCA 
                                                                   City Tax Form
 Live in a CCA municipality     municipality AND city tax was 
                                                                       section A
                                withheld 

                                ZRUN LQ D GLႇHUHQW PXQLFLSDOLW\    City Tax Form
 Live in a CCA municipality
                                from which you live                sections A, B, B-1

                                work or earn income in a CCA       City Tax Form 
 Live in a CCA municipality     municipality AND city tax was      sections A, A-1, 
                                not withheld                           B, B-1
                                work or earn income in a CCA 
                                                                   City Tax Form
 Live in a non CCA municipality municipality AND city tax was 
                                                                   sections A, A-1
                                not withheld

  EXEMPTION CERTIFICATE
 Print or type your name and address in the spaces provided. If you have moved during 
   the year, show both your current and your old address in the spaces provided. Be sure 
   to enter the date of change.
 Write your Social Security Number on the form.
 )RU WKRVH ZKR OLYH LQ D PDQGDWRU\ ¿OLQJ FRPPXQLW\ DQG DUH H[HPSW IURP SD\LQJ WD[HV   
   check the appropriate Box 1 through 4.
 If you ceased doing business or sold your rental property in a CCA community prior to 
   January 1, 202 2check Box 5.
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 'HWDFK DQG PDLO WKH FRPSOHWHG ERWWRP SRUWLRQ RI ([HPSWLRQ &HUWL¿FDWH WR WKLV RႈFH 
 Keep the top portion for your records. 

 STOP²,I \RX TXDOLI\ DQG KDYH FRPSOHWHG WKH ([HPSWLRQ &HUWL¿FDWH  \RX DUH QRW UHTXLUHG 
 WR ¿OH WKH &LW\ 7D[ )RUP 
  CITY TAX FORM

 Extension – Check the box and attach a copy of Federal Extension Form 4868 or
   electronic acknowledgement.
 Filing Status – Check the appropriate box.
 Print or type your name and address in the spaces provided.     If you moved during
   the year, show both your current and your old address in the spaces provided. Be
   sure to enter the date of change.
 Write your Social Security Number on your return.
 Enter your city of residence and phone number.

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 LINE INSTRUCTIONS
List all of your income by source on Lines 1 through 6. If additional space is needed, please attach 
a separate schedule. Each item of income that you list in this section must be brought down and 
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/LQH      (QWHU  WKH  HPSOR\HU¶V  QDPH   FLW\  ZKHUH  ZRUN  ZDV  SHUIRUPHG  DQG  WKH  ORFDO  ZDJHV  DV 
  shown on Wage and Tax Statements (Forms W-2). 
  Report the full amount of your wages, salaries, bonuses, tips, fees, commissions, 
  supplemental pay, sick pay, short term disability pay, excess reimbursements and other 
  income regardless of whether municipal income tax has been withheld by your employer. 
  Enter your taxable wages by employer as shown on Forms W-2. For city tax purposes 
  deferred compensation is taxable, use medicare wage in box 5, which usually is the 
  KLJKHVW ZDJH ¿JXUH  Tips reported to your employer are treated as wages and reported 
  on Line 1. Tips not reported to your employer should be treated as miscellaneous income 
  on Line 6.
Line 2 -  Enter total taxable wage income.
127(  &&$ UHVLGHQWV WKDW KDYH QHW SUR¿W GLVWULEXWLYH VKDUH LQFRPH VRXUFHG LQ PXOWLSOH 
municipalities with current and/or prior year losses should complete the CCA Resident 
Business/Rental Income Worksheet in lieu of lines 3,4,5 and 6 business income. The 
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/LQH   ± 1DPH  WKH  FLW\  DQG  HQWHU  RQO\  WKH  QHW  SUR¿W  IURP  6FKHGXOH  &  RU  6FKHGXOH  )   
  Attach a copy of the Federal Schedules and a breakdown if income was earned in  
  more than one municipality.
/LQH   ± 1DPH  WKH  FLW\  DQG  HQWHU  RQO\  WKH  UHQWDO  SUR¿W  IURP  6FKHGXOH  (   $WWDFK  D  FRS\  RI 
  your Federal Schedule E.
Line 5 – Name the city and enter income from Partnerships, Sub Chapter S Corporations 
  and  Trusts.  Attach copies of Federal Schedules E Part II and K-1. Partnerships, 
  Estates and  Trusts, Sub Chapter S Corporations (subject to residence municipal 
  RUGLQDQFH   DQG  /LPLWHG  /LDELOLW\  &RPSDQLHV  QRW  ¿OLQJ  RQ  D  6FKHGXOH  &   PXVW  ¿OH 
  DQG  SD\  WD[  DV  HQWLWLHV  XVLQJ  1HW  3UR¿W  $QQXDO   )RUP  &&$            ,QGLYLGXDOV 
  may take credit for taxes paid by these entities on their distributive share income.  
  (DFK HQWLW\¶V JDLQ RU ORVV LV WD[HG VHSDUDWHO\ WR \RX DV DQ LQGLYLGXDO  A loss from one 
  HQWLW\ PD\ QRW EH XVHG WR RႇVHW D JDLQ IURP DQRWKHU HYHQ LI ERWK HQWLWLHV DUH ZLWKLQ 
  the same municipality.
Line 6 – Name the city and enter any other income received from estates and trusts, raffles,  
contests, and other miscellaneous income reported on Form 1099. 

Business, Rental and Other Income and Losses
Losses from either business or rental property must be documented on Schedule L, on the back 
of the return. Losses may be carried forward for five (5) years (subject to municipal ordinance). 

Business or rental income may be decreased by business or rental losses. Business and rental 
losses may not be deducted directly from wages. If a loss is realized, the loss is carried forward 
by the partnership to offset any possible future gains. Residents of CCA taxing municipalities with 
net profit and/or distributive share income sourced in multiple municipalities with current and/or 
prior year losses see CCA rules and Regulations Article 11 and the CCA Resident Business/
Rental Income Worksheet.

Net Loss Carried Forward Limitation – For taxable years beginning in 2019, 2020, 2021 and 2022 
you may only deduct net operating losses prescribed by ORC 718 for losses incurred in taxable 
years beginning on or after January 1, 2017.  The remaining unused portion of the net operating 
loss may be carried forward, but for no more than five consecutive taxable years following the 
year in which the loss occurred.
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 SECTION A - EMPLOYMENT / PROFIT TAX 2022
 Use this section to calculate the tax that you owe on your wages (Line 2) and on the income 
 you have received from business (Line 3), rental property (Line 4), K-1 (Line 5) and other 
 sources (Line 6). Combine your income by city and list each only once in Section A. Be sure 
 to keep the tax due, the credits or the amounts withheld separate for each city. 
 Column 1 – List the name of each city where work was performed or income earned. List 
               each city only once.
 Column 2 – Combine and enter the taxable income for each city. List income for each city 
               only once.
 Column 3 – Enter the work city tax rate.
 Column 4 – To calculate the Tax Due, multiply the Taxable Income in Column 2 by the Tax 
               Rate in Column 3.
 Column 5 – Enter the tax that has been withheld for each city by your employer or the 
               amount of tax that you have paid directly to a NON-CCA city or tax paid by a 
               partnership or Sub Chapter S Corporation.
 STOP – If all of your wages were earned in the same city in which you lived, and city 
            tax was correctly withheld, complete only the green sections. Sign and date 
            WKH UHWXUQ  DWWDFK \RXU )RUPV :    DQG ¿OH WKH UHWXUQ ZLWK &&$ 
 Column 6 Enter the amount of overpayment from 202 1that you applied toward 202 .2
 Column 7 – Enter the amount of employment tax estimate payments that were applied to 
               2022.
 Column 8 – If the Tax Due is $10.00 or less enter zero. If the Tax Due is positive and greater 
               than $10.00, then this is the amount of employment tax you owe to each city.  
               Overpayments greater than $10.00 may be credited or refunded. 
               Enter the amount of the overpayment on line 11. The overpayment cannot be  
               subtracted from the Tax Due to another city.
 Line 10 –   Add all the positive amounts in Column 8 to arrive at the total employment tax 
               that you owe.
 NOTE: Tax due to a NON-CCA city cannot be paid on this return. CCA member 
 municipalities are listed on the reverse of the tax return. Call the city hall of the NON-
 &&$ PXQLFLSDOLW\ WR REWDLQ LQIRUPDWLRQ RQ ¿OLQJ D WD[ UHWXUQ DQG SD\LQJ WD[ GXH 
 Line 11 –    Add the negative amounts in column 8 to arrive at the total amount of 
               overpayment. Enter the amount you want to credit towards next year or claim 
               as a refund. The credit or refund amount must be greater than $10.00 per city.
 127(   7D[  RYHUSDLG  WR  D  121 &&$  FLW\  FDQQRW  EH  XVHG  WR  RႇVHW  WD[  GXH  D  &&$ 
 municipality. CCA member municipalities are listed on the reverse of the tax return. 
 &DOO WKH FLW\ KDOO RI WKH 121 &&$ PXQLFLSDOLW\ WR REWDLQ LQIRUPDWLRQ RQ ¿OLQJ D WD[ 
 return and requesting a refund for that overpayment.

 SECTION A-1 EMPLOYMENT / PROFIT TAX                       ESTIMATE - 2032
 If there was employment tax due to a CCA municipality in 202 2and you expect to owe 
 $200.00 or more in employment tax in 202 3(after subtracting your estimated withholding 
 DQG FUHGLWV   \RX PXVW ¿OH DQ (PSOR\PHQW 3UR¿W 7D[ (VWLPDWH   VXEMHFW WR PXQLFLSDO  
 ordinance)
 You may be charged penalty and interest if you fail to timely pay quarterly estimated 
 payments totaling at least 90% of the current tax year liability or 100% of the prior tax 
 liability. If you do not know what you will owe in 2023, base your estimate on the amount of 
 tax due for 2022.
 (VWLPDWHV PD\ EH DPHQGHG LI D VLJQL¿FDQW LQFUHDVH RU GHFUHDVH LQ LQFRPH RFFXUUHG GXULQJ  
 the current tax year. If you fail to complete the estimate, CCA will not automatically bill you.
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Column   9 – List employment cities where you expect to owe tax. 
Column 10 – Estimate income for these cities and calculate the tax due. Be sure to use 2023
             tax rates.
Column 11 List any overpayment from line 11A which you want credited to 202 3tax.
Column 12 Subtract Column 11 from Column 10 and enter that amount in Column 12.              
             7KLV  DPRXQW  UHÀHFWV  WKH  EDODQFH  RI  HVWLPDWHG  HPSOR\PHQW  WD[  GXH  IRU     3 
Column 13 – Divide the amount in Column 10 by four (4) and subtract Column 11. This amount
             LV WKH ¿UVW TXDUWHU LQVWDOOPHQW  ,I WKH DPRXQW LV ]HUR RU OHVV  QR SD\PHQW LV GXH WKLV  
             quarter. You may pay the balance due at this time or in quarterly installments.
Line 13 -    Total all Columns.

 SECTION B – RESIDENCE TAX – 2022
Residence tax may be due on income earned outside your CCA residence city. First refer to the
6FKHGXOH 5 RQ WKH UHYHUVH RI  WKH WD[ UHWXUQ  7KH 6FKHGXOH  5 UHÀHFWV  WKH  DGMXVWHG  WD[  UDWH  XVHG  
to calculate the tax that is owed to your residence city. This tax is in addition to any tax paid in 
Section A and should not be confused with taxes paid to employment cities. After completing 
the Schedule R Worksheet, return to Section B Residence Tax 2022.
Schedule R Worksheet
NOTE: If you use the CCA Resident Business/Rental Income Worksheet do not include income 
IURP WKH ZRUNVKHHW RQ 6FKHGXOH 5  5HVLGHQWV RI &&$ PXQLFLSDOLWLHV WKDW KDYH QHW SUR¿W DQG  
or distributive share income sourced in multiple municipalities with current and/or prior year 
losses should complete the CCA Resident Business/Rental Income Worksheet which may be 
REWDLQHG IURP ZZZ FFDWD[ FL FOHYHODQG RK XV RU E\ FRQWDFWLQJ RXU RႈFH 

Column 1 –  Enter name of work city. If more than one city, list each city separately. If work
             city is the same as residence city, enter city name on line ** of the Schedule R 
             Worksheet. There is no additional residence tax due for income earned in the same 
             city in which you live. 
Column 2 –  Enter total income earned in each city listed in Column 1.  The total of Column 2
             should be the same as the total of Column 15 in Section B – Residence Tax 2021 
             on the front of the tax return. If you lived in more than one city while you earned this 
             income, the income will need to be prorated to show the amount earned while living 
             in each residence city. To prorate your income, take your total income and divide it by 
             twelve (12). This will approximate your monthly income. Multiply your monthly income 
             by the number of months that you lived in each of the cities.
Column 3 –   Enter name of the city that you lived in while you earned the income in Column 2.
Column 4 –  To locate your adjusted residence tax rate:
              D   )LQG WKH :25. &,7< 5$7( LQ WKH VKDGHG DUHD RI 6&+('8/( 5   7R ¿QG WKH WD[ 
                 rate of a non-CCA municipality you can ask your employer or the city hall of that 
                 municipality.
             (b) Follow that WORK CITY column down until you reach the row naming your
                 residence city
             (c) Circle that percentage and enter in Column 4 of the Schedule R Worksheet
Column 5 –   Multiply Column 2 by Column 4 and enter the tax due your residence city.  The 
             total of Column 5 should be entered in Column16 Section B – Residence  
             Tax 202 2 on the front of the tax return.
Section B – Residence Tax 2022
Column 14 List the name of each city where you lived during 202 .2
Column 15 – Enter the total of taxable income for each residence city. (Schedule R, Col. 2) 
Column 16 – Enter the total tax due for each residence city. (Schedule R, Col. 5)
Column 17 – Enter the Residence Tax Withheld by your employer (Forms W-2).         Residence 
             tax withheld is a separate withholding and should not be confused with 
             employment tax withheld. 
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 Column 18 Enter the amount of overpayment from 202 1that you applied toward 2022 .
 Column 19 – Enter the amount of residence tax estimate payments that were applied to
              2022.
 Column 20 – If the Tax Due amount is $10.00 or less enter zero. If the Tax Due is positive  
              and greater than $10.00, then this is the amount of residence tax you owe.  
              Overpayments greater than $10.00 may be credited or refunded. 
              Enter the amount of the overpayment on Line 16. The overpayment cannot be 
              subtracted from the Tax Due to another city.
 Line 15 –    Add the positive amounts in Column 20 to arrive at the total residence tax that 
              you owe.
 Line 16 –    Add the negative amounts in Column 20 to arrive at the total amount of
              overpayment. Enter the amount you want to credit towards next year or claim 
              as a refund.The credit or refund amount must be greater than $10.00 per city.

 SECTION B-1 - RESIDENCE TAX ESTIMATE – 2023
 If there was residence tax due in 202 2and you expect to owe $200.00 or more in residence 
 WD[  LQ     3   DIWHU  VXEWUDFWLQJ  \RXU  HVWLPDWHG  ZLWKKROGLQJ  DQG  FUHGLWV    \RX  PXVW  ¿OH  D  
 Residence Tax  Estimate. (Subject to municipal ordinance)

 You may be charged penalty and interest if you fail to timely pay quarterly estimated payments 
 totaling at least 90% of the current tax year liability or 100% of the prior tax liability.  If you do 
 not know what you will owe in 202 3base your estimate on the amount of tax due for 2022. 

 (VWLPDWHV PD\ EH DPHQGHG LI D VLJQL¿FDQW LQFUHDVH RU GHFUHDVH LQ LQFRPH RFFXUUHG GXULQJ  
 the current tax year. 

 If you fail to complete the estimate, CCA will not automatically bill you.  
 Column 21 – List the residence city.
 Column 22 – Estimate income and tax due for your residence city. Calculate the tax due just 
                   as you did in Section B. Be sure to use 202 3tax rates.
 Column 23 List any overpayment from Line 16A which you want credited to 202 3 tax.
 Column 24 – Subtract Column 23 from Column 22 and enter that amount in Column 24. This
              DPRXQW UHÀHFWV WKH EDODQFH RI HVWLPDWHG UHVLGHQFH WD[ GXH IRU    3 
 Column 25 – Divide the amount in Column 22 by four (4) and subtract Column 23. This 
              DPRXQW  LV  WKH  ¿UVW  TXDUWHU  LQVWDOOPHQW   ,I  WKH  DPRXQW  LV  ]HUR  RU  OHVV  
              no payment is due this quarter. You may pay the balance due at this time or  
              in quarterly installments.
 Line 17 –    Total all columns.
 Line 18 –    Add amounts shown in the last column of lines 10, 13,15 and 17 for the total
              amount you must remit to CCA.

  MAILING YOUR RETURN
   Verify social security number(s).
   Check your calculations.
   Attach all Wage and Tax Statements (Forms W-2) and all schedules to the tax return.
   Attach a check, money order or credit card authorization to the front of the form. Be
     VXUH  WR ZULWH \RXU WD[SD\HU LGHQWL¿FDWLRQ QXPEHU RQ \RXU UHPLWWDQFH   
     Place remittance on top of tax statements.
   Sign, date and mail your return by the due date.
   Keep a copy for your records.
8



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                               TAX RATE SCHEDULE
                          CCA MEMBER MUNICIPALITIES
                                     2022                                                      2023
                          MUST WORK  RESIDENCE     CREDIT                              WORK    RESIDENCE
MUNICIPALITY              FILE RATE  CREDIT        LIMIT                               RATE        CREDIT
Burton                         1%    50%           .50                                  1%                  50%
Clayton                        1.5%  50%           .75                                 1.5%                 50%
Cleveland                      2.5%  100%          2.5                                 2.5%                100%
Dalton                         1%    100%          1%                                   1%                 100%
Elida                          .75%  0%            0                                   .75%                 0%
Geneva-on-the-Lake             1.5%  ***           1                                   1.5%                 ***
Germantown                     1.5%  60%           .90                                 1.5%                 60%
Grand Rapids                   1%    50%           .50                                  1%                  50%
Grand River                    2%    100%          2                                    2%                 100%
Highland Hills                 2.5%  100%          2.5                                 2.5%                100%
Linndale                       2%    100%          2                                    2%                 100%
Marble Cliff                   2%    100%          2                                    2%                 100%
Mentor-on-the-Lake             2%    100%          2                                    2%                 100%
Montpelier                     1.6%  100%          1.6                                 1.6%                100%
Munroe Falls                   2.25% 100%          2.25                                2.25%               100%
New Carlisle                   1.5%  0%            0                                   1.5%                 0%
New Madison                    1%    100%          1                                    1%                 100%
New Miami                      1.75% 100%          1.75                                1.75%               100%
New Paris                      1%    *             .50                                  1%                  *
North Baltimore                1%    0%            0                                    1%                  0%
North Randall                  2.75% 100%          2.75                                2.75%               100%
Oakwood (Paulding County)      1%    100%          1                                    1%                 100%
Obetz                          2.5%  100%          2.5                                 2.5%                100%
Orwell                         1.5%  100%          1.5                                 1.5%                100%
Paulding                       1.1%  0%            0                                   1.1%                 0%
Phillipsburg                   1.5%  ***           1                                   1.5%                 ***
Pitsburg                       1%    0%            0                                    1%                  0%
Riverside                      2.5%  100%          2.50                                2.5%                 100%
Rock Creek                     1%    100%          1                                    1%                 100%
Russells Point                 1%    0%            0                                    1%                  0%
Seville                        1%    0%            0                                    1%                  0%
Shreve                         1%    *             .50                                  1%                  *
South Russell                  1.25% **            .94                                 1.25%                **
Union                          1.5%  100%          1.5                                 1.5%                100%
Waynes ield                    1%    100%          1                                    1%                 100%
West Milton                    1.5%  0%            0                                   1.5%                 0%

* Residence credits are limited to one half of 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 percent when work is outside residence city.
****  Residence credits are limited to 50% of the City/Village tax rate when work is outside residence city.






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