Form 37a - Individual Income Tax Return
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1
2REGIONAL INCOME TAX AGENCY
PHONE:
CLEVELAND LOCAL (440) 526-0900
FORM
COLUMBUS LOCAL
(614) 538-0512
2003
INDIVIDUAL INCOME TAX RETURN
37A
TDD
(440) 526-5332
IF YOU ARE EXEMPT FROM FILING,
TOLL FREE
1-800-860-7482
P.O. Box 89474 Cleveland, Ohio 44101-6474
CHECK THIS BOX AND FILL OUT THE
DECLARATION OF EXEMPTION ON
OBTAIN FORMS AT
THE BACK OF THIS FORM.
IF YOU’VE OVERPAID, INDICATE YOUR CHOICE
INDICATE FILING STATUS BELOW:
Social Security Number
Spouses Social Security Number
Refund
Credit
Single
Joint
First Name
M.I.
Last Name
First Name
M.I.
Last Name
Address Number
Street Name
Apt. #
City
State
Zip Code
Daytime Phone
ENTER THE MUNICIPALITY
YOU LIVED IN FOR THE TAX
YEAR
Section A
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
COLUMN F
COLUMN G
MUNICIPALITY WHERE
WAGES
CREDIT LIMIT
COLUMN B X COLUMN C
TAX WITHHELD TO
LESSER OF
TAX WITHHELD FOR
WAGES WERE EARNED
(LIST EACH W-2)
(RESIDENT CITY)
COLUMN D OR COLUMN E
RESIDENT MUNICIPALITY
ANOTHER MUNICIPALITY
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
Section A
Totals
.00
.00
.00
T-1
T-2
T-3
Note: If you want RITA to calculate your 2003 tax liability, sign the form and attach W-2(s) Do not complete Section B
Section B
1.
1. Enter total wages from Section A, T-1
2.
2. Multiply Line 1 by Tax Rate of residence municipality
3.
3. Enter allowable credit from Section A, T-2
4.
4. Multiply Line 3 by Tax Credit of residence municipality
5.
5. Enter tax amount withheld from Section A, T-3
6.
6. Line 6 – Subtract Line 4 and Line 5 from Line 2 and enter here
Note: Cannot be less than zero. If less than zero, complete Form 10A
7.
7. Estimated Tax payments made to RITA for tax year 2003
8.
8. Credits carried forward from 2002
9.
9. Total credits allowable (Add lines 7 and 8)
BALANCE DUE
10.
10. Subtract Line 9 from Line 6 and enter on Line 10 if greater than zero.
REFUND
11.
11. If Line 10 is Less than zero, and you want a refund, enter the amount on line 11
CREDIT
12.
12. If Line 10 is Less than zero, and you want a credit, enter the amount on line 12
13.
13. Enter 2004 Estimated Tax (NOTE: IF LINE 13 IS LEFT BLANK, RITA WILL CALCULATE AN ESTIMATE FOR YOU)
14.
14. Enter first quarter 2004 estimate (1/4 of line 13)
15. AMOUNT DUE by April 30, 2004 (Line 10 + Line 14 - Line 12)
15.
Please make check or money order payable to R.I.T.A.
SIGNATURE
DATE
SPOUSE’S SIGNATURE
DATE
Preparer’s Signature (Other Than Taxpayer)
DATE
ADDRESS
ID NUMBER
THE ABOVE SIGNED DECLARES THAT THIS RETURN IS TRUE, CORRECT AND COMPLETE FOR THE TAX YEAR 2003.
Page 1
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