| CCA – DIVISION OF TAXATION 2023 216. 664. 2070 800. 223. 6317 www. ccatax. ci. cleveland. oh. us Individual Municipal Income Tax Forms Tax forms due April 15, 2024 eFile with CCA at https://efile. ccatax. ci. cleveland. oh. us Social Security No. – – – – Read the instruction booklet to determine whether you have taxable income for municipal income tax purposes. If you have taxable income, complete and file the City Tax Form. If you have no taxable income for municipal purposes, complete and file the Exemption Certificate below. CCA MEMBER MUNICIPALITIES Burton Grand Rapids New Carlisle Orwell Shreve Clayton Grand River New Madison Paulding Somerset Cleveland Highland Hills New Miami Phillipsburg South Russell Dalton Linndale New Paris Pitsburg Union Edon Marble Cliff North Baltimore Riverside Waynesfield Elida Mentor-on-the-Lake North Randall Rock Creek West Milton Geneva-on-the-Lake Montpelier Oakwood ( Paulding County) Russells Point Germantown Munroe Falls Obetz Seville EXEMPTION CERTIFICATE I LIVE IN A MANDATORY FILING COMMUNITY AND I AM NOT REQUIRED TO PAY MUNICIPAL INCOME TAX BECAUSE: 1. RETIRED, received only pension, Social Security, interest or 4. NO EARNED INCOME FOR THE ENTIRE YEAR @ dividend income @ 2023. ( Public Assistance, Unemployment, SSI, etc.) 2. MEMBER OF THE ARMED FORCES OF THE 5. BUSINESS CLOSED OR RENTAL PROPERTY @ UNITED STATES FOR THE ENTIRE YEAR 2023. ( This does not @ SOLD prior to 1/1/23. include civilians employed by the military or National Guard.) 3. UNDER 18 FOR THE ENTIRE YEAR 2023. * @ see reverse for exceptions IF EXEMPT, COMPLETE, DETACH AND RETURN THE EXEMPTION CERTIFICATE IN THE ENCLOSED ENVELOPE. KEEP TOP PORTION FOR YOUR RECORDS. IF YOU ARE NOT FILING THIS EXEMPTION CERTIFICATE, PLEASE DISCARD. CCA – DIVISION OF TAXATION 205 W SAINT CLAIR AVE 2023 EXEMPTION CERTIFICATE CLEVELAND OH 44113-1503 SHOW NAME OR ADDRESS CHANGES ON REVERSE. Name @ Social Security No. – – Name of spouse if joint return – – Current address Apt. # City State Zip I LIVE IN A MANDATORY FILING COMMUNITY AND I AM NOT REQUIRED TO PAY MUNICIPAL INCOME TAX BECAUSE: 1. RETIRED, received only pension, Social Security, Interest or Dividend Income 4. NO EARNED INCOME FOR THE ENTIRE YEAR 2023. 2. @ MEMBER OF THE ARMED FORCES OF THE UNITED @ ( Public Assistance, Unemployment, SSI, etc.) @ STATES FOR THE ENTIRE YEAR 2023. ( This does not include 5. BUSINESS CLOSED OR RENTAL PROPERTY SOLD prior to 1/1/23. civilians employed by the military or National Guard.) @ 3. UNDER 18 FOR THE ENTIRE YEAR 2023. @ * see reverse for exceptions Do you authorize your preparer to contact us regarding this return? YES NO SIGNATURE OF TAXPAYER SIGNATURE OF SPOUSE, PHONE NUMBER SIGNATURE OF PREPARER, DATE @ @ IF JOINT RETURN IF NOT TAXPAYER IF YOU ARE NOT FILING THIS EXEMPTION CERTIFICATE, PLEASE DISCARD. *All individuals who are 18 years of age and older are subject to local income tax. Note: Montpelier, Munroe Falls, New Paris, Oakwood, Obetz, Phillipsburg, Riverside and Somerset 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 who earn $2, 500. 00 or more are subject to the tax. To request a refund complete a City Tax Form and attach the refund worksheet. SHOW NAME AND ADDRESS CHANGES BELOW Taxpayer Name Social Security No. – – Name of spouse if joint return – – Address Apt. # Move In / / City State Zip Move Out / / CCA – DIVISION OF TAXATION — Due April 15, 2024 216. 664. 2070 • 800. 223. 6317 2023–City Tax Form www. ccatax. ci. cleveland. oh. us 90% payment due January 15, 2024 Refund Amended to avoid penalty and interest ( see ordinance) Individual Joint Extension Attached CCA FORM 120-16-IR TAXABLE INCOME Name Social Security No. 1. Employer’s Name CITY INCOME – – a. Name of spouse if joint return b. – – Current address Apt. # Move In c. / / d. City, State, Zip Move Out 2. Total Wages Attach W-2s ( or 1099s ) / / IF MOVED DURING THE YEAR SHOW CHANGES BELOW 3. Business Income Attach Schedule C PRINT OR TYPE ( ) Schedule E – – 4. Rental Income ( Attach ) Attach – – 5. K-1 Income ( Schedule E & K-1 ) Move In / / 6. Other Income Source Move Out CITY OF RESIDENCE PHONE NUMBER / / ( ) – NOTE: IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE YELLOW SECTIONS ONLY, SIGN, DATE, ATTACH W-2 FORMS AND MAIL RETURN. ALL OTHERS SEE INSTRUCTIONS AND COMPLETE FORM IN ITS ENTIRETY. SECTION A Employment / Profit Tax 2023 L COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7 COLUMN 8 Less: Tax I Work City Name Work Withheld ( Attach Less: Tax Tax Due CCA N List Each City City Tax W-2) Or Less: Prior Paid On ( If $10. 00 or less Employment E Only Once Taxable Income Rate Tax Due Paid Other Cities Year Credit Tax Estimate enter zero) 9 Total each column. Add positive 10 figures only in Column 8. If a negative figure is shown in Column 8, enter as credit or refund. 11a CREDIT 11b REFUND 11 The credit or refund amount must be greater than $10. 00. SECTION A-1 Employment / Profit Tax Estimate 2024 ( See instructions) – must be completed to receive 2024 Estimated Bills COLUMN 9 COLUMN 10 COLUMN 11 COLUMN 12 COLUMN 13 Estimated 2023 Credit Balance Payment Due Work City Tax Due ( From Col. 8 only) ( Col. 10 Less Col. 11) ( ¼ of Col. 10 less Col. 11) 12 13 Total each column. SECTION B Residence Tax 2023 ( Refer to Schedule R Worksheet on reverse of form before proceeding to Line 14) COLUMN 14 COLUMN 15 COLUMN 16 COLUMN 17 COLUMN 18 COLUMN 19 COLUMN 20 Tax Due Less: Residence Less: Tax Paid Tax Due CCA Tax Withheld Less: Prior On Residence ( If $10. 00 or less Residence City Taxable Income Schedule R ( Attach W-2) Year Credit Tax Estimate enter zero) 14 14a Total each column. Add positive PLACE CHECK, MONEY ORDER OR CREDIT CARD AUTHORIZATION ON TOP. MUST ATTACH W-2 BELOW REMITTANCE. 15 figures only in Column 20. If a negative figure is shown in Column 20, enter as credit or refund. 16a CREDIT 16b REFUND 16 The credit or refund amount must be greater than $10. 00. SECTION B-1 Residence Tax Estimate 2024 ( See instructions) – must be completed to receive 2024 Estimated Bills COLUMN 21 COLUMN 22 COLUMN 23 COLUMN 24 COLUMN 25 Estimated 2023 Credit Balance Payment Due Residence City Residence Tax ( From Line 16a only) ( Col. 22 Less Col. 23) ( ¼ of Col. 22 less Col. 23) 17 Total each column. Tax Due with this return – Add figures shown in last column of Lines 10-13-15-17 18 Write Taxpayer Identification Number on remittance. Make check payable to CCA - Division of Taxation. I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX PURPOSES ADJUSTED TO MUNICIPAL INCOME TAX ORDINANCES. Do you authorize your preparer to contact us regarding this return? YES NO SIGN Signature of Taxpayer @ Signature @ of Spouse, if joint return DATE Signature of Preparer, if not Taxpayer DATE HERE NO Payment Enclosed - Mail to: Payment Enclosed - Mail to: Refund Request - Mail to: MAIL CCA – DIVISION OF TAXATION CCA – DIVISION OF TAXATION CCA – DIVISION OF TAXATION TO PO BOX 94810 PO BOX 94723 PO BOX 94520 Cleveland OH 44101-4810 Cleveland OH 44101-4723 Cleveland OH 44101-4520 ↵ ↵ CCA – DIVISION OF TAXATION CREDIT CARD AUTHORIZATION DETACH HERE TO CHARGE YOUR INCOME TAX DUE YOU MUST COMPLETE THE FOLLOWING: CHECK ONE VISA MASTERCARD MASTERCARD AMERICAN EXPRESS Taxpayer’s name Taxpayer’s Social Security No. – – Cardholder’s name Cardholder’ addresss Apt. # City State Zip ACCOUNT NUMBER TOTAL AMOUNT CHARGED $ EXPIRATION DATE V CODE / CARDHOLDER’S AUTHORIZED SIGNATURE DATE MO. YR. SCHEDULE L Schedule of Business and Rental Losses Note: Business and/or rental losses may be carried forward for five ( 5) years. A loss in one city may offset a business or rental City Year End Taxable Income or Loss Allowable Loss From Prior Year Total Adjusted Income gain in the same city. See municipal ordinance for exceptions. Individuals with net profit/distributive share income sourced in multiple municipalities with current and/or prior year losses refer to the CCA Resident Business/Rental Income Worksheet. SCHEDULE R ADJUSTED RESIDENCE CITY PERCENTAGE RATES ( FIND YOUR WORK CITY RATE IN THE SHADED AREA BELOW) MUNICIPALITY NO TAX WITH- . 5% . 75% 1% 1. 1% 1. 12% 1. 2% 1. 25% 1. 4% 1. 5% 1. 6% 1. 65% 1. 75% 1. 8% 2% 2. 1% 2. 25% 2. 4% 2. 5% 2. 6% 2. 75% 3. 0% HELD Burton 1 . 75 . 63 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Clayton 1. 5 1. 25 1. 13 1 . 95 . 94 . 90 . 88 . 80 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 Cleveland 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Dalton ( 2023) 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Dalton ( 2024) 1. 5 1. 00 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Edon 1. 75 1. 25 1 . 75 . 65 . 63 . 55 . 50 . 35 . 25 . 15 . 10 0 0 0 0 0 0 0 0 0 0 Elida . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 Geneva-on-the-Lake 1. 5 1 . 75 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Germantown 1. 5 1. 2 1. 05 . 90 . 84 . 83 . 78 . 75 . 66 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 Grand Rapids 1 . 75 . 63 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Grand River 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Highland Hills 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Linndale 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Marble Cliff 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Mentor-on-the-Lake 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Montpelier 1. 6 1. 10 . 85 . 60 . 50 . 48 . 40 . 35 . 20 . 10 0 0 0 0 0 0 0 0 0 0 0 0 Munroe Falls 2. 25 1. 75 1. 5 1. 25 1. 15 1. 13 1. 05 1 . 85 . 75 . 65 . 60 . 50 . 45 . 25 . 15 0 0 0 0 0 0 New Carlisle 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 New Madison 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 New Miami 1. 75 1. 25 1 . 75 . 65 . 63 . 55 . 50 . 35 . 25 . 15 . 10 0 0 0 0 0 0 0 0 0 0 New Paris 1 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 North Baltimore 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 North Randall 2. 75 2. 25 2 1. 75 1. 65 1. 63 1. 55 1. 5 1. 35 1. 25 1. 15 1. 1 1 . 95 . 75 . 65 . 50 . 35 . 25 . 15 0 0 Oakwood ( Paulding County) 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Obetz 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Orwell 1. 5 1 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Paulding 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 Phillipsburg 1. 5 1 . 75 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Pitsburg 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Riverside 2. 5 2. 0 1. 75 1. 5 1. 4 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Rock Creek 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Russells Point 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Seville 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Shreve 1 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 | CCA – DIVISION OF TAXATION 2023 216. 664. 2070 800. 223. 6317 www. ccatax. ci. cleveland. oh. us Individual Municipal Income Tax Forms Tax forms due April 15, 2024 eFile with CCA at https://efile. ccatax. ci. cleveland. oh. us Social Security No. – – – – Read the instruction booklet to determine whether you have taxable income for municipal income tax purposes. If you have taxable income, complete and file the City Tax Form. If you have no taxable income for municipal purposes, complete and file the Exemption Certificate below. CCA MEMBER MUNICIPALITIES Burton Grand Rapids New Carlisle Orwell Shreve Clayton Grand River New Madison Paulding Somerset Cleveland Highland Hills New Miami Phillipsburg South Russell Dalton Linndale New Paris Pitsburg Union Edon Marble Cliff North Baltimore Riverside Waynesfield Elida Mentor-on-the-Lake North Randall Rock Creek West Milton Geneva-on-the-Lake Montpelier Oakwood ( Paulding County) Russells Point Germantown Munroe Falls Obetz Seville EXEMPTION CERTIFICATE I LIVE IN A MANDATORY FILING COMMUNITY AND I AM NOT REQUIRED TO PAY MUNICIPAL INCOME TAX BECAUSE: 1. RETIRED, received only pension, Social Security, interest or 4. NO EARNED INCOME FOR THE ENTIRE YEAR @ dividend income @ 2023. ( Public Assistance, Unemployment, SSI, etc.) 2. MEMBER OF THE ARMED FORCES OF THE 5. BUSINESS CLOSED OR RENTAL PROPERTY @ UNITED STATES FOR THE ENTIRE YEAR 2023. ( This does not @ SOLD prior to 1/1/23. include civilians employed by the military or National Guard.) 3. UNDER 18 FOR THE ENTIRE YEAR 2023. * @ see reverse for exceptions IF EXEMPT, COMPLETE, DETACH AND RETURN THE EXEMPTION CERTIFICATE IN THE ENCLOSED ENVELOPE. KEEP TOP PORTION FOR YOUR RECORDS. IF YOU ARE NOT FILING THIS EXEMPTION CERTIFICATE, PLEASE DISCARD. CCA – DIVISION OF TAXATION 205 W SAINT CLAIR AVE 2023 EXEMPTION CERTIFICATE CLEVELAND OH 44113-1503 SHOW NAME OR ADDRESS CHANGES ON REVERSE. Name @ Social Security No. – – Name of spouse if joint return – – Current address Apt. # City State Zip I LIVE IN A MANDATORY FILING COMMUNITY AND I AM NOT REQUIRED TO PAY MUNICIPAL INCOME TAX BECAUSE: 1. RETIRED, received only pension, Social Security, Interest or Dividend Income 4. NO EARNED INCOME FOR THE ENTIRE YEAR 2023. 2. @ MEMBER OF THE ARMED FORCES OF THE UNITED @ ( Public Assistance, Unemployment, SSI, etc.) @ STATES FOR THE ENTIRE YEAR 2023. ( This does not include 5. BUSINESS CLOSED OR RENTAL PROPERTY SOLD prior to 1/1/23. civilians employed by the military or National Guard.) @ 3. UNDER 18 FOR THE ENTIRE YEAR 2023. @ * see reverse for exceptions Do you authorize your preparer to contact us regarding this return? YES NO SIGNATURE OF TAXPAYER SIGNATURE OF SPOUSE, PHONE NUMBER SIGNATURE OF PREPARER, DATE @ @ IF JOINT RETURN IF NOT TAXPAYER IF YOU ARE NOT FILING THIS EXEMPTION CERTIFICATE, PLEASE DISCARD. *All individuals who are 18 years of age and older are subject to local income tax. Note: Montpelier, Munroe Falls, New Paris, Oakwood, Obetz, Phillipsburg, Riverside and Somerset 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 who earn $2, 500. 00 or more are subject to the tax. To request a refund complete a City Tax Form and attach the refund worksheet. SHOW NAME AND ADDRESS CHANGES BELOW Taxpayer Name Social Security No. – – Name of spouse if joint return – – Address Apt. # Move In / / City State Zip Move Out / / CCA – DIVISION OF TAXATION — Due April 15, 2024 216. 664. 2070 • 800. 223. 6317 2023–City Tax Form www. ccatax. ci. cleveland. oh. us 90% payment due January 15, 2024 Refund Amended to avoid penalty and interest ( see ordinance) Individual Joint Extension Attached CCA FORM 120-16-IR TAXABLE INCOME Name Social Security No. 1. Employer’s Name CITY INCOME – – a. Name of spouse if joint return b. – – Current address Apt. # Move In c. / / d. City, State, Zip Move Out 2. Total Wages Attach W-2s ( or 1099s ) / / IF MOVED DURING THE YEAR SHOW CHANGES BELOW 3. Business Income Attach Schedule C PRINT OR TYPE ( ) Schedule E – – 4. Rental Income ( Attach ) Attach – – 5. K-1 Income ( Schedule E & K-1 ) Move In / / 6. Other Income Source Move Out CITY OF RESIDENCE PHONE NUMBER / / ( ) – NOTE: IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE YELLOW SECTIONS ONLY, SIGN, DATE, ATTACH W-2 FORMS AND MAIL RETURN. ALL OTHERS SEE INSTRUCTIONS AND COMPLETE FORM IN ITS ENTIRETY. SECTION A Employment / Profit Tax 2023 L COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7 COLUMN 8 Less: Tax I Work City Name Work Withheld ( Attach Less: Tax Tax Due CCA N List Each City City Tax W-2) Or Less: Prior Paid On ( If $10. 00 or less Employment E Only Once Taxable Income Rate Tax Due Paid Other Cities Year Credit Tax Estimate enter zero) 9 Total each column. Add positive 10 figures only in Column 8. If a negative figure is shown in Column 8, enter as credit or refund. 11a CREDIT 11b REFUND 11 The credit or refund amount must be greater than $10. 00. SECTION A-1 Employment / Profit Tax Estimate 2024 ( See instructions) – must be completed to receive 2024 Estimated Bills COLUMN 9 COLUMN 10 COLUMN 11 COLUMN 12 COLUMN 13 Estimated 2023 Credit Balance Payment Due Work City Tax Due ( From Col. 8 only) ( Col. 10 Less Col. 11) ( ¼ of Col. 10 less Col. 11) 12 13 Total each column. SECTION B Residence Tax 2023 ( Refer to Schedule R Worksheet on reverse of form before proceeding to Line 14) COLUMN 14 COLUMN 15 COLUMN 16 COLUMN 17 COLUMN 18 COLUMN 19 COLUMN 20 Tax Due Less: Residence Less: Tax Paid Tax Due CCA Tax Withheld Less: Prior On Residence ( If $10. 00 or less Residence City Taxable Income Schedule R ( Attach W-2) Year Credit Tax Estimate enter zero) 14 14a Total each column. Add positive PLACE CHECK, MONEY ORDER OR CREDIT CARD AUTHORIZATION ON TOP. MUST ATTACH W-2 BELOW REMITTANCE. 15 figures only in Column 20. If a negative figure is shown in Column 20, enter as credit or refund. 16a CREDIT 16b REFUND 16 The credit or refund amount must be greater than $10. 00. SECTION B-1 Residence Tax Estimate 2024 ( See instructions) – must be completed to receive 2024 Estimated Bills COLUMN 21 COLUMN 22 COLUMN 23 COLUMN 24 COLUMN 25 Estimated 2023 Credit Balance Payment Due Residence City Residence Tax ( From Line 16a only) ( Col. 22 Less Col. 23) ( ¼ of Col. 22 less Col. 23) 17 Total each column. Tax Due with this return – Add figures shown in last column of Lines 10-13-15-17 18 Write Taxpayer Identification Number on remittance. Make check payable to CCA - Division of Taxation. I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX PURPOSES ADJUSTED TO MUNICIPAL INCOME TAX ORDINANCES. Do you authorize your preparer to contact us regarding this return? YES NO SIGN Signature of Taxpayer @ Signature @ of Spouse, if joint return DATE Signature of Preparer, if not Taxpayer DATE HERE NO Payment Enclosed - Mail to: Payment Enclosed - Mail to: Refund Request - Mail to: MAIL CCA – DIVISION OF TAXATION CCA – DIVISION OF TAXATION CCA – DIVISION OF TAXATION TO PO BOX 94810 PO BOX 94723 PO BOX 94520 Cleveland OH 44101-4810 Cleveland OH 44101-4723 Cleveland OH 44101-4520 ↵ ↵ CCA – DIVISION OF TAXATION CREDIT CARD AUTHORIZATION DETACH HERE TO CHARGE YOUR INCOME TAX DUE YOU MUST COMPLETE THE FOLLOWING: CHECK ONE VISA MASTERCARD MASTERCARD AMERICAN EXPRESS Taxpayer’s name Taxpayer’s Social Security No. – – Cardholder’s name Cardholder’ addresss Apt. # City State Zip ACCOUNT NUMBER TOTAL AMOUNT CHARGED $ EXPIRATION DATE V CODE / CARDHOLDER’S AUTHORIZED SIGNATURE DATE MO. YR. SCHEDULE L Schedule of Business and Rental Losses Note: Business and/or rental losses may be carried forward for five ( 5) years. A loss in one city may offset a business or rental City Year End Taxable Income or Loss Allowable Loss From Prior Year Total Adjusted Income gain in the same city. See municipal ordinance for exceptions. Individuals with net profit/distributive share income sourced in multiple municipalities with current and/or prior year losses refer to the CCA Resident Business/Rental Income Worksheet. SCHEDULE R ADJUSTED RESIDENCE CITY PERCENTAGE RATES ( FIND YOUR WORK CITY RATE IN THE SHADED AREA BELOW) MUNICIPALITY NO TAX WITH- . 5% . 75% 1% 1. 1% 1. 12% 1. 2% 1. 25% 1. 4% 1. 5% 1. 6% 1. 65% 1. 75% 1. 8% 2% 2. 1% 2. 25% 2. 4% 2. 5% 2. 6% 2. 75% 3. 0% HELD Burton 1 . 75 . 63 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Clayton 1. 5 1. 25 1. 13 1 . 95 . 94 . 90 . 88 . 80 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 Cleveland 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Dalton ( 2023) 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Dalton ( 2024) 1. 5 1. 00 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Edon 1. 75 1. 25 1 . 75 . 65 . 63 . 55 . 50 . 35 . 25 . 15 . 10 0 0 0 0 0 0 0 0 0 0 Elida . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 . 75 Geneva-on-the-Lake 1. 5 1 . 75 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Germantown 1. 5 1. 2 1. 05 . 90 . 84 . 83 . 78 . 75 . 66 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 . 60 Grand Rapids 1 . 75 . 63 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Grand River 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Highland Hills 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Linndale 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Marble Cliff 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Mentor-on-the-Lake 2 1. 5 1. 25 1 . 90 . 88 . 80 . 75 . 60 . 50 . 40 . 35 . 25 . 20 0 0 0 0 0 0 0 0 Montpelier 1. 6 1. 10 . 85 . 60 . 50 . 48 . 40 . 35 . 20 . 10 0 0 0 0 0 0 0 0 0 0 0 0 Munroe Falls 2. 25 1. 75 1. 5 1. 25 1. 15 1. 13 1. 05 1 . 85 . 75 . 65 . 60 . 50 . 45 . 25 . 15 0 0 0 0 0 0 New Carlisle 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 New Madison 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 New Miami 1. 75 1. 25 1 . 75 . 65 . 63 . 55 . 50 . 35 . 25 . 15 . 10 0 0 0 0 0 0 0 0 0 0 New Paris 1 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 North Baltimore 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 North Randall 2. 75 2. 25 2 1. 75 1. 65 1. 63 1. 55 1. 5 1. 35 1. 25 1. 15 1. 1 1 . 95 . 75 . 65 . 50 . 35 . 25 . 15 0 0 Oakwood ( Paulding County) 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Obetz 2. 5 2 1. 75 1. 5 1. 40 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Orwell 1. 5 1 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Paulding 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 1. 1 Phillipsburg 1. 5 1 . 75 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 Pitsburg 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Riverside 2. 5 2. 0 1. 75 1. 5 1. 4 1. 38 1. 3 1. 25 1. 1 1 . 90 . 85 . 75 . 70 . 50 . 40 . 25 . 10 0 0 0 0 Rock Creek 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Russells Point 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Seville 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Shreve 1 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 . 50 |
| South Russell 1. 25 . 88 . 69 . 50 . 43 . 41 . 35 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 Union 1. 5 1 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Waynesfield 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 West Milton 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 SCHEDULE R WORKSHEET - DO NOT INCLUDE INCOME REPORTED ON THE CCA RESIDENT BUSINESS / RENTAL INCOME WORKSHEET COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 WORK CITY TAXABLE INCOME RESIDENCE CITY SCHEDULE R TAX RATE RESIDENCE TAX DUE FROM ABOVE COLUMN 2 TIMES COLUMN 4 % % % ** TOTALS Enter totals on tax return LINE 14, COLUMN 15 LINE 14, COLUMN 16 SCHEDULE R WORKSHEET INSTRUCTIONS Do not include income reported on the CCA Resident Business/Rental Income Worksheet. Column 1 Enter name of your work city. If more than one city, list each city separately. If work city is the same as residence city, enter name of work city on the ** line. NOTE: Income earned in same city you live in with employment tax withheld correctly is not subject to residence tax. Column 2 Enter total income earned in each city listed in Column 1. Add all figures and enter total on front of form on line 14, column 15. Column 3 Enter name of residence city. If residence city changed during year, prorate Column 2. Column 4 To locate your adjusted residence tax rate: ( a) Find the WORK CITY RATE in the shaded area of SCHEDULE R. ( 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. Column 5 Multiply Column 2 by Column 4 and enter the tax due. Add all figures and enter total on front of form on line 14, column 16. PDF file checksum: | South Russell 1. 25 . 88 . 69 . 50 . 43 . 41 . 35 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 . 31 Union 1. 5 1 . 75 . 50 . 40 . 38 . 30 . 25 . 10 0 0 0 0 0 0 0 0 0 0 0 0 0 Waynesfield 1 . 50 . 25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 West Milton 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 1. 5 SCHEDULE R WORKSHEET - DO NOT INCLUDE INCOME REPORTED ON THE CCA RESIDENT BUSINESS / RENTAL INCOME WORKSHEET COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 WORK CITY TAXABLE INCOME RESIDENCE CITY SCHEDULE R TAX RATE RESIDENCE TAX DUE FROM ABOVE COLUMN 2 TIMES COLUMN 4 % % % ** TOTALS Enter totals on tax return LINE 14, COLUMN 15 LINE 14, COLUMN 16 SCHEDULE R WORKSHEET INSTRUCTIONS Do not include income reported on the CCA Resident Business/Rental Income Worksheet. Column 1 Enter name of your work city. If more than one city, list each city separately. If work city is the same as residence city, enter name of work city on the ** line. NOTE: Income earned in same city you live in with employment tax withheld correctly is not subject to residence tax. Column 2 Enter total income earned in each city listed in Column 1. Add all figures and enter total on front of form on line 14, column 15. Column 3 Enter name of residence city. If residence city changed during year, prorate Column 2. Column 4 To locate your adjusted residence tax rate: ( a) Find the WORK CITY RATE in the shaded area of SCHEDULE R. ( 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. Column 5 Multiply Column 2 by Column 4 and enter the tax due. Add all figures and enter total on front of form on line 14, column 16. PDF file checksum: |