Fillable 2015 City Tax Form printable pdf download

2015 City Tax Form

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CCA – DIVISION OF TAXATION

2015–City Tax Form

— Due April 18, 2016

Clear Form

216.664.2070 • 800.223.6317

Individual

Joint

Extension Attached

TAXABLE INCOME

CCA FORM 120-16-IR

1. . Employer’s Name

CITY

INCOME

Social Security No.

Name

–

Name of spouse if joint return

– –

Current address

Apt. #

Move In

(

)

City, State, Zip

Move Out

Attach W -2s

Total Wages

or 1099s

(

)

Less Allowable

Attach Fed. 2106

& Schedule A

2106 Expenses

IF MOVED DURING THE YEAR SHOW CHANGES BELOW

(

)

Line 2 less

Net Taxable Wages

$0.00

Line 3

(

)

Attach

– –

Business Income

Schedule C

(

)

Attach

Rental Income

Schedule E

– –

(

)

Attach

K-1 Income

Move In

Schedule E & K-1

Other Income Source

Move Out

CITY OF RESIDENCE

PHONE NUMBER

(

)

–

NOTE:

IF TOTAL WAGES WERE EARNED IN THE SAME CITY YOU LIVED IN AND CITY TAX WAS CORRECTLY WITHHELD, COMPLETE GREEN SECTIONS ONLY, SIGN,

DATE, ATTACH W-2 FORMS AND MAIL RETURN. ALL OTHERS SEE INSTRUCTIONS AND COMPLETE FORM IN ITS ENTIRETY.

SECTION A

COLUMN 2

COLUMN 3

COLUMN 4

COLUMN 1

COLUMN 5

COLUMN 6

COLUMN 7

COLUMN 8

Rate

Cities

Select City

$0.00

Select City

$0.00

Select City

$0.00

Select City

$0.00

Total each column. Add Positive

$0.00

Figures

in Column 8.

CREDIT

REFUND

in Column 8, enter as

Enter amount to be credited to

Enter amount to be

credit or refund.

refunded

2016 here and in Column 11

SECTION A-1

COLUMN 9

COLUMN 10

COLUMN 11

COLUMN 12

COLUMN 13

Select City

$0.00

Select City

$0.00

Total each column.

SECTION B

COLUMN 20

COLUMN 14

COLUMN 18

COLUMN 19

COLUMN 15

COLUMN 16

COLUMN 17

Click here to go to calculation area

$0.00

Total each column. Add Positive

$0.00

Figures only in Column 20.

CREDIT

REFUND

in Column 20, enter as

Enter amount to be

Enter amount to be credited

credit or refund.

refunded

to 2016 here and in Column 23

SECTION B-1

COLUMN 25

COLUMN 21

COLUMN 23

COLUMN 24

COLUMN 22

$0.00

Select City

$0.00

Select City

$0.00

Total each column.

Add Figures Shown in Last Column of Lines 10-13-15-17

$0.00

I DECLARE THAT I HAVE EXAMINED THIS RETURN AND ACCOMPANYING SCHEDULES AND STATEMENTS. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS 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

Signature of Preparer, if not Taxpayer

Signature of Taxpayer

Signature of Spouse, if Joint Return

DATE

SIGN

HERE