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5               Regional Income Tax Agency 
         32 
                Estimated Income Tax and/or 
EST-EXT         Extension of Time to File 

SSN #:                                    Spouse’s SSN#:       

Name:           __________________________________________________________________________ 

Spouse’ s Name: _______________________________________________________________________                      

Address #:                         Street:                                                 Suite:          _ 

City:                              __         State:                            Zip:                       _ 

**See Page 2 for EXTENSION instructions**

SECTION 1:  ESTIMATED INCOME TAX DECLARATION 

Use this section to report or update your Annual Estimated Income Tax Liability. If you anticipate owing 
$200 or more in municipal income tax, you must estimate your taxes and make quarterly payments as your 
income is earned.  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.  Form  37 
Instructions “Worksheet 2” may be used to calculate your Estimated Income Tax Liability.  

                                                           Tax Year                     Amount 

          Total Estimated Income Tax                                            $                      .00 

SECTION 2: PAYMENT (Balance due on annual return and/or estimated payment) 

1. Anticipated Tax Balance Due on 202    2 Annual Return                        $                    .00
 (Extension Payment)
2.202 3Estimated Tax Payment (not less than 1/4 of Total Estimate)              $                    .00
      If you are making an estimated payment enter the amount on Line 2.  
      This line will NOT update your 2023 total estimated tax liability. If you 
      anticipate owing $200 or more in municipal income tax, you must 
      estimate your taxes and make quarterly payments as your income 
      is earned.  If you need to report or update your 2023 Total Estimated 
      IncomeTax  enter in Section 1.  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. 
3. Amount Paid (Add Lines 1 and 2)                                              $                    0 .00
      (make check payable to RITA see page 2 for mailing address)

4. Allocate to applicable RITA Municipalities Balance Due from Line 1 and/or Estimated Tax from Line 2.

►     Municipality:                       Tax Year:                                Amount: 
                                                                                $                    .00
                                                                                $                    .00
                                                                                $                    .00
                                                                                $                    .00
                                                                                $                    .00

                                        Total allocation (equal Line 3 above)    $                   0 .00

SECTION 3:  EXTENSION OF TIME TO FILE 

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 2022.      

If you have requested or received an extension to file your federal income tax return, your 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 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 municipal income tax return by indicating your request in Section        3
above, and submitting this request on or before the filing due date of April 1 ,8202 .  3
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 2 to pay the tax due for tax year 2022 and the first quarter of
estimated payments due for tax year 2023.  

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. 

Your Signature:                                                                Date: 

Spouse’s Signature:                                                            Date: 
(If filing jointly, BOTH must sign) 

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 Declaration/Extension to: 
With Payment made payable to RITA:          Without Payment:  
REGIONAL INCOME TAX AGENCY                  REGIONAL INCOME TAX AGENCY 
P.O. BOX 6600                               P.O. BOX 477900 
CLEVELAND, OH 44101-2004                    BROADVIEW HEIGHTS 44147-7900 

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