5             Regional Income Tax Agency
              Net Profit Estimated Income Tax 
20-EXT        and/or Extension of Time to File

Fed. ID #: 

Name: 

Address #:                     Street:                                                  Suite: 

City:                          __                  State:                     Zip: 

Phone #: 

  Check this box if you are updating your Net Profit Annual Estimated Income Tax Liability and complete Section 
  1 below. Do NOT check this box if you are only making an Estimated Tax payment.  

SECTION 1: ESTIMATED INCOME TAX COMPUTATION and ESTIMATED PAYMENT 
Use this section to report or update  Net Profit  Estimated Income  Tax Liabilities  and/or make an estimated 
payment. If your business anticipates owing $200 or more in municipal income tax, you must estimate your taxes 
and make quarterly payments.  If your estimated payments are either less than 90% of the tax due, or not equal 
to or greater than your prior year's total tax liability, you will be subject to penalty and interest.     

Tax Year Ending _____________ 

1. Total Estimated Tax (distribute to each applicable municipality in Line 5) $                 .00
 Note: Line 1 must equal Line 6
2. Less Prior Year Credit                                                     $                 .00

3. Total Estimated Tax Due                                                    $                 .00

4. Estimated Payment (not less than 1/4 of Line 3)                            $                 .00
 Note: Make check payable to RITA. See below for mailing address

5. Distribute Estimated Tax from Line 1 above (if additional space is needed, attach a schedule)

►     Municipality:                                                             Amount: 
                                                                              $                 .00

                                                                              $                 .00

                                                                              $                 .00

                                                                              $                 .00

                                                                              $                 .00

                                                                              $                 .00

                                                                              $                 .00

6. Total Estimated Tax distribution from Line 5 (Line 6 must equal Line 1)    $                 0 .00

Mail to: 
REGIONAL INCOME TAX AGENCY 
P.O. BOX 94582  
CLEVELAND, OH 44101-4582 

Fax: 440.922.3536

Fed. ID #:                                                                  Phone #: 

  SECTION 2:  EXTENSION OF TIME TO FILE 

If your business has requested or received an extension to file your federal income tax return, your Net Profit 
municipal income tax return is extended as well.  It is not necessary to file a copy of your federal extension with 
RITA by the annual filing due date.  Attach a copy of the federal extension when filing your Net Profit municipal 
income tax return on or before the extended due date.   
If you have not requested or received a federal income tax filing extension, you may receive a six-month 
extension for filing your Net Profit municipal income tax return by checking the box below, and submitting 
this request on or before the filing due date or the 15 thday of the fourth month following the taxpayer s fiscal’
year-end.   
An extension to file the annual return is not an extension to pay - the tax owed is still due by the annual filing 
due date.  Please complete Section 3 to pay the tax due for the applicable tax year.  
  If you have a copy of your federal extension, you do NOT have to fill out this section.   Check this box if you 
  have NOT requested or received a federal extension and you are requesting a 6 month extension to file for 
  the tax year ending _________.      

SECTION 3:  EXTENSION PAYMENT 

Tax Year Ending _____________ 

1. Anticipated Tax Balance Due on Net Profit Annual Return                  $                       .00
(Extension payment)
2. Distribute Tax Balance Due (if additional space is needed, attach a schedule)
Note: Do not include estimated tax payments, see Section 1 for
Estimated Tax Computation and Payments
►    Municipality:                                                            Amount: 
                                                                            $                       .00
                                                                            $                       .00
                                                                            $                       .00
                                                                            $                       .00
                                                                            $                       .00
                                                                            $                       .00
                                                                            $                       .00

3. Total Tax Balance distribution from Line 2 (Line 3 must equal Line 1)                        0 .00

SECTION 4: VERIFICATION 

Taxpayer – Under penalties of perjury, I declare that to the best of my knowledge and       belief, the statements 
made herein are true and correct. 
Signature:                                                                      Date: 

Preparer other than taxpayer – Under penalties of perjury, I declare that to the best of my knowledge and              
belief, the statements made herein are true and correct, that I am authorized by the taxpayer to prepare this 
Declaration and/or Extension.  
Signature of Preparer:                                                          Date: 

Printed Name of Preparer: 
May RITA discuss this Declaration/Extension with the preparer above?                             Yes           No     
Mail to: 
REGIONAL INCOME TAX AGENCY 
P.O. BOX 94582
CLEVELAND, OH 44101-4582                                                                                   Page 2 

Fax to: 440.922.3536