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                                                                                        INSTALLMENT SCHEDULE FOR ESTIMATED PAYMENTS
2023 ESTIMATE TAX FORM                                                       1st Qtr    January, February, March       25% due April 15th 
                                                                               2nd Qtr   April, May, June                50% due June 15th 
                                                                               3rd Qtr   July, August, September         75% due September 15th
                CCA DIVISION OF TAXATION                                     4th Qtr    October, November, December    100% due January 15th 
                205 W SAINT CLAIR AVE                                          When the 15th falls on a Saturday, Sunday or legal holiday, payment is considered 
                CLEVELAND OH 44113-1503                                        timely if made on or before the next succeeding day that is not a Saturday, Sunday 
                216.664.2070    800.223.6317                                   or legal holiday.
                www.ccatax.ci.cleveland.oh.us                                  If you estimate that you will owe at least $200.00 in municipal income tax (after 
                                                                               subtracting your estimated withholding and credits), you should make quarterly 
    Check box if AMENDED. Estimates may be amended if a significant            estimated payments. You may be charged penalty and interest if you fail 
    increase or decrease in income occurred during the current tax year.       to timely pay quarterly estimated payments totaling at least 90% of the current tax 
                                                                               year liability or 100% of the prior year tax liability.
                                                                                                 IF MOVED DURING THE YEAR, SHOW PRIOR ADDRESS BELOW
                                                    —            —
Name                                     Social Security No.                         Name                                      Name
                                                    —            —
Name of spouse if joint return           Social Security No.                         Prior address                             Prior address

Current address                                                                     City State Zip                             City State Zip

City State Zip                                                                      Date of Move                               Date of Move

EMPLOYMENT / PROFIT TAX  ESTIMATE
IF EMPLOYMENT TAX IS WITHHELD GO TO RESIDENCE TAX SECTION
Column 1 – List CCA municipalities where employment, business or rental property is located 
Column 2 – Enter estimated taxable income 
Column 3 – Enter tax rate: CCA Member municipality tax rates are listed on the back of this form 
Column 4 – Multiply Col. 2 estimated taxable income by Col. 3 tax rate and enter amount as estimated tax due 
Column 5 – Enter installment due. Multiply Col. 4 by quarterly percentage. Refer to INSTALLMENT SCHEDULE FOR ESTIMATED PAYMENTS
Column 6 – Enter prior year credit 
Column 7 – Enter tax paid to date for current year estimate
Column 8 – Enter balance due. Col. 5 minus (Col. 6 plus Col. 7). If negative enter zero. Add all figures and enter total.
       COLUMN 1            COLUMN 2         COLUMN 3             COLUMN 4            COLUMN 5           COLUMN 6         COLUMN 7                COLUMN 8
  CCA Employment City          Estimated    Tax Rate             Estimated           Installment        Prior Year       Prior Estimate          Balance Due
                         Taxable Income                    Employment/Profit Tax Due        Due              Credit      Payments

                                                                                                                         TOTAL ( A )
RESIDENCE TAX  ESTIMATE
COMPLETE SCHEDULE R WORKSHEET ON REVERSE OF FORM
Column 9  –  Enter residence city name 
Column 10 – Enter total from Schedule R Worksheet Col. 5 
Column 11 – Enter installment due. Multiply Col.10 by quarterly percentage. Refer to INSTALLMENT SCHEDULE FOR ESTIMATED PAYMENTS 
Column 12 – Enter prior year credit 
Column 13 – Enter tax paid to date for current year estimate 
Column 14 – Enter balance due.  Col. 11 minus (Col. 12 plus Col. 13). Add all figures and enter total.  
       COLUMN 9                     COLUMN 10                       COLUMN 11                          COLUMN 12         COLUMN 13               COLUMN 14
    Residence City             Estimated Residence                  Installment Due                    Prior Year Credit Prior Estimate          Balance Due
                                     Tax Due                                                                             Payments

                                                                                                                         TOTAL ( B )

                                                                                                                         TOTAL ( A + B )
TAX DUE WITH THIS RETURN
MAIL COMPLETED FORM WITH PAYMENT TO CCA - DIVISION OF TAXATION AT THE ABOVE ADDRESS. MAKE CHECK PAYABLE TO CCA - DIVISION OF TAXATION.
I HAVE EXAMINED THIS DECLARATION AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT       Do you authorize your preparer to contact us regarding this return?  YES  NO 
                                                                                                                                                              @  @

Signature of Taxpayer                       Signature of Spouse                      Date               Signature of Preparer, if not taxpayer   Date
CCA FORM 120-202ES (Rev. 12/22)



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                                                                         SCHEDULE R
                                                                 ADJUSTED RESIDENCE CITY PERCENTAGE RATES 
RESIDENCE                                             (FIND YOUR WORK CITY RATE IN THE SHADED AREA BELOW)
MUNICIPALITY              NO TAX  .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%
                          WITHHELD
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                    1       .5   .25    0  0    0          0   0    0    0       0    0         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
Somerset                  1       1    1      1  1    1          1   1    1    1       1    1         1   1   1     1   1   1          1           1      1   1
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 INSTRUCTIONS
      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 estimated taxable income earned in each city listed in Col. 1 
      Column 3     Enter name of residence city. If residence city changed during year, prorate Col. 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 Col. 4
      Column 5     Multiply Col. 2 by Col. 4 and enter the estimated residence tax due. Add all figures and enter total on front of form in Col. 10
                SCHEDULE R WORKSHEET
                          COLUMN 1               COLUMN 2                   COLUMN 3                  COLUMN 4          COLUMN 5
                          WORK CITY           ESTIMATED TAXABLE           RESIDENCE                   SCHEDULE R        ESTIMATED
                                                 INCOME                        CITY                   ADJUSTED RATE RESIDENCE TAX DUE

                **






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