Fillable Form 17: 3 1 Regional Income Tax Agency (RITA Ohio)

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Form 17: 3 1 Regional Income Tax Agency (RITA Ohio)

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The Form 17: 3 1 Regional Income Tax Agency (RITA Ohio) form is 2 pages long and contains:

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Period
January
February
March
April
May
June
July
August
September
October
November
December
Total
4
2
1
Tax Year:
Workplace Wages Workplace Tax Withheld Residence Tax Withheld
Totals must be distributed by municipality on Page 2 in Section 5.
(if additional space is needed, attach a separate schedule)
OUT OF BUSINESS
Due on or before the last day of February of the following year.
Fed. ID #:
Name:
Address #:
Street Name:
City:
State:
Suite:
Zip Code:
IF THIS IS AN AMENDED
RETURN CHECK HERE
Page
1
MOVED OUT OF RITA
Total number of employees working in a
RITA member municipality(ies) at year
end:
3
Total number of W-2’s enclosed:
Total number of 1099-NEC enclosed:
17
Form
Regional Income Tax Agency
Reconciliation of Income Tax
Withheld and W-2/1099-NEC Transmittal
PRINT FORM
RESET FORM
0.00
0.00
0.00
7
8
Workplace Wages
Workplace
Tax Rate %
Workplace Tax Residence Tax
Workplace Wages
Workplace
Tax Rate %
Workplace Tax Residence Tax
Workplace Wages
Workplace
Tax Rate %
Workplace Tax Residence Tax
Workplace Wages
Workplace
Tax Rate %
Workplace Tax Residence Tax
Total Workplace Wages
Municipality
Number of employees
at year end
TOTAL: Must equal totals on Page 1 from Section 4.
I have examined this return and to the best of my knowledge it is correct.
Title Date
Phone:
Signature
Municipality
Number of employees
at year end
Municipality
Number of employees
at year end
Municipality
Number of employees
at year end
Municipality
Number of employees
at year end
Workplace W
ages
W
orkplace
Tax Rate %
Workplace Tax Residence Tax
Total Workplace Tax
Total Residence Tax
Total number of
employees at year end
5
6
Note: If you file a Form 17 as a professional employer organization (PEO), common pay master, co-employer, or other agent providing
payroll services to unrelated third party employers, including, but not limited to, clients, subsidiaries, other companies, etc., you must also
provide specific information on each of these employers. Use Schedule R-17 to report for each employer EIN and Name and to allocate
the Workplace Wages, Workplace Tax Withheld, Residence Tax Withheld and RITA Municipality.
Print Name
Page
2
9
Fed. ID #:
v21.1
Mail to: Attn RITA
P.O. BOX 715170
CINCINNATI, OH 45271-5170
Fax: 440.922.3536
For OVERNIGHT mail: Attn RITA
P.O.BOX 715170
895 CENTRAL AVENUE SUITE 600
CINCINNATI, OH 45202-5703
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Form 17: 3 1 Regional Income Tax Agency (RITA Ohio)

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Completed 19 January 2022

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