Fillable FORM 11A Regional Income Tax Agency Adjusted Employer's (RITA Ohio)

Fill Online, Printable, Fillable, Blank FORM 11A Regional Income Tax Agency Adjusted Employer's (RITA Ohio) Form

Use Fill to complete blank online RITA OHIO pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FORM 11A Regional Income Tax Agency Adjusted Employer's (RITA Ohio)

On average this form takes 28 minutes to complete

The FORM 11A Regional Income Tax Agency Adjusted Employer's (RITA Ohio) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 112 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your RITA Ohio forms online.

BROWSE RITA OHIO FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
FORM
11A
1. Name: ______________________________________________
_
Fed. ID#: ____________________________
_
Address #: ______________
_
Street: ____________________________________________________________
_
City: _____________________________________________
_
State: _____
_
Zip: _____________________
_
2. Originally Filed
For the period ______/______/________ to ______/______/________
MM DD YYYY MM DD YYYY
Municipality Workplace Workplace Tax Residence Tax Total Tax
Wages Withheld Withheld Withheld
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
Total
s
$
_________
_
$
______
_
$
______
$
_______
3. Adjusting To
Municipality Workplace Workplace Tax Residence Tax Total Tax
Wages Withheld Withheld Withheld
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
_
__________________
_
$__________________
$______________ $_____________ $_______________
Total
s
$
_________
_
$
______
_
$
______
$
_______
▲
▲
▲
4. Balance Due $_____________
5. Overpayment $_____________
Refund
Credi
t
(Must distribute in Section 7)
Regional Income Tax Agency
Adjusted Employer's Municipal Tax
Withholding Statement
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
6. Reason for Adjusting (Must Be Provided)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
7.
Distribution of Overpaymen
t
(From Section 5)
Municipality
Amoun
t
Distribute Credit to
Tax Period
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
_
__________________
_
$__________________ ______/______/_________
MM DD YYYY
8. I HAVE EXAMINED THIS RETURN, AND TO THE BEST OF MY KNOWLEDGE, IT IS CORRECT.
Print Name: _____________________________________
Title: _______________________________
Signature: _______________________________ Date: ___________ Phone: ______-______-________
Remit to: REGIONAL INCOME TAX AGENCY -- P.O. BOX 477900 BROADVIEW HEIGHTS, OH 44147-7900
Fax: 440.922.3536
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FORM 11A Regional Income Tax Agency Adjusted Employer's (RITA Ohio)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 January 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document