Individual Estimate Form - Cca - Cleveland - 2017
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2INSTALLMENT SCHEDULE FOR ESTIMATED PAYMENTS
2017 – 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 December 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.
If you estimate that you will owe at least $200.00 in municipal income tax for
2017 (after subtracting your estimated withholding and credits), you should make
Check box if AMENDED. Estimates may be amended if a significant
quarterly 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 communities 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 CENTRAL COLLECTION AGENCY AT THE ABOVE ADDRESS. MAKE CHECK PAYABLE TO CENTRAL COLLECTION AGENCY
@
Do you authorize your preparer to contact us regarding this return? YES
NO
I HAVE EXAMINED THIS DECLARATION AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT
Date
Date
Signature of Taxpayer
Signature of Spouse
Signature of Preparer, if not taxpayer
CCA FORM 120-202ES (Rev. 02/17)
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