Cca Form 120-18 - Application For Refund Page 2
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1
2WORKSHEET FOR MULTIPLE EMPLOYERS
Wages and Taxes Reported on W-2 Form:
Employer’s Name
Wages per W-2
Tax Withheld
City Name
1.)
$
$
2.)
$
$
$
$
3.)
+
+
Total Wages:
Total Tax Withheld:
$
$
enter on front page Line 1
enter on front page Line 5
Adjustments to Taxable Income:
Wages per W-2
-
Wages not Subject to Tax
=
Net Taxable Wages
1.)
-
=
$
$
2.)
$
$
-
=
-
=
$
$
3.)
+
+
Total Amount Not Subject to Tax:
Total Net Taxable Wages:
$
$
enter on front page Line 3
enter on front page Line 2
Computation of Corrected Tax:
City Worked
Net Taxable Wages
Tax Rate
Corrected Tax
1.)
X
=
$
%
$
2.)
$
%
$
X
=
X
=
$
%
$
3.)
+
Total Corrected Tax: enter on front page Line 4
$
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