Due April 18, 2023, or CCA – DIVISION OF TAXATION
2022–Net Profit Tax Return 105 days from end of fiscal year. 216.664.2070 • 800.223.6317
www.ccatax.ci.cleveland.oh.us
Calendar Year 2022 or Tax Year Beginning And Ending
90% payment due no later than 15 days before the close of tax year. (see ordinance) Extension Attached
CCA FORM 120-17-BR @
1DPH RI %XVLQHVV Federal Identification Number
$GGUHVV Trade Name
$GGUHVV Local Business Address
&LW\ 6WDWH =LS Principal Business Activity Code Phone No.
PRINT OR TYPE
Check status as a taxpayer: Partnership Corporation Subchapter S. Corp. Other
Computation of City Taxable Income@ – Enclose@ complete@ Federal Return with@all attachments.
1. INCOME PER ATTACHED FEDERAL TAX RETURN–Attach copy of Federal Return, including all attachments (see
instructions) Form 1120, Line 28; Form 1120-A, Line 24; Form 1120S, Sch. K Line 18; Form 1120-REIT, Line 20;
Form 1065, “Analysis of Net Income (Loss)”; Form 1041, Line 17; Form 990 T, Line 30 (1) $
2. A. ITEMS ADDED BACK TO INCOME (From Line M, Schedule X Below) ADD (2A.) $
B. ITEMS DEDUCTED FROM INCOME (From Line Z, Schedule X Below) DEDUCT (2B.) $
C. ENTER EXCESS OF LINE 2A OR 2B (2C.) $
3. A. ADJUSTED FEDERAL TAXABLE INCOME (Line 1 plus or minus Line 2C) IF SCHEDULE X IS USED (3A.) $
B. AMOUNT ALLOCABLE TO CCA MUNICIPALITIES FROM SCHEDULE Y (see instructions) % OF LINE 3A ..... (3B.) $
C. LESS ALLOWABLE AND UNEXPIRED NET OPERATING LOSS (Complete Schedule Y–Part B) (3C.) $
4. AMOUNT SUBJECT TO MUNICIPAL INCOME TAX (Line 3A or 3B less Line 3C) (4) $
Net Profits Tax Distribution – Enclose complete Federal Return with all attachments.
For Office L COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7A COLUMN 7B COLUMN 7C
I List all cities where work Less: Tax
Use Only N actually performed or Net Tax Tax Less: Prior Paid on Profit Net Tax
E business located Taxable Income Rate Due Year Credit Tax Estimate Due Credit Refund
5.
6. Total each
column
SCHEDULE X Adjustments to income per Federal Tax Return as reported on Line 1 of this form
Items to be ADDED back to income per attached Federal Return (as Items to be DEDUCTED from income per Federal Return (as reported
reported on Line 1 of this form) on Line 1 of this form)
A. CAPITAL LOSSES AND ORDINARY LOSSES N. CAPITAL GAINS
(SEE INSTRUCTIONS) $ (EXCLUDING ORDINARY GAINS) $
B. EXPENSES ATTRIBUTABLE TO NON-TAXABLE
INCOME (5% of Line Z less Line N) $ O. DIVIDENDS $
C. TAXES BASED ON INCOME $ P. INTEREST INCOME $
D. AMOUNTS PAID OR ACCRUED ON BEHALF $
OF OWNERS FOR QUALIFIED SELF- Q. ROYALTY INCOME $
EMPLOYED RETIREMENT PLANS, HEALTH
AND/OR LIFE INSURANCE
R. OTHER (attach explanation) $
E. OTHER (attach explanation) $
M. TOTAL ADDITIONS (Enter as Line 2A above) $ Z. TOTAL DEDUCTIONS (Enter as Line 2B above) $
LOSS CARRYFORWARD SCHEDULE Note: This 5-year Loss Carryforward Schedule must be completed, or a similar schedule
attached to this return that includes all required information–see instructions.
CCA MEMBER 1 2022 UNAPPORTIONED ADJ FED 2 2017, 2018, 2019, 2020, 2021 3 ADJUSTED 2022 1 For each municipality with
TAXABLE INC (AFTER SCH X ADJ.) UNAPPORTIONED NOL @ 50% UNAPPORTIONED AFTI apportionable income this amount
(ENTER AS NEGATIVE) should equal line 3 A. on the Net
Profit return
2 See ORC 718.01(D)(3)
3 Enter this amount in Schedule
Y - Part A and Multiply by your
apportionment ratio to determine
taxable income for the Municipality/
Jedd(z)
I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF THEY ARE 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
@ @
Signature of Officer or Partner (Date) Signature of Person or Firm Preparing the Return (Date)
Title Address of Preparer
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