5
Regional Income Tax Agency
Estimated Income Tax and/or
Extension of Time to File
SSN #: Spouse’s SSN#:
Name:
__________________________________________________________________________
Spouses Name: _______________________________________________________________________
Address #:
Street:
Suite:
_
__City: State:
Zip:
_
SECTION 1: ESTIMATED INCOME TAX DECLARATION
Use this section to report or update your Annual Estimated Income Tax Liability. If you anticipate owing
$200 or more in municipal income tax, you must estimate your taxes and make quarterly payments as your
income is earned. If your estimated payments are either less than 90% of the tax due, or not equal to or
greater than your prior year's total tax liability, you will be subject to penalty and interest. Form 37
Instructions “Worksheet 2” may be used to calculate your Estimated Income Tax Liability.
Tax Year
Amount
Total Estimated Income Tax
$
.00
SECTION 2: PAYMENT (Balance due on annual return and/or estimated payment)
$ .00
1. Anticipated Tax Balance Due on 2020 Annual Return
(Extension Payment)
2. 2021 Estimated Tax Payment (not less than 1/4 of Total Estimate)
$ .00
3. Amount Paid (Add Lines 1 and 2) $ .00
(make check payable to RITA see page 2 for mailing address)
4. Allocate to applicable RITA Municipalities Balance Due from Line 1 and/or Estimated Tax from Line 2.
Municipality: Tax Year: Amount:
$ .00
$ .00
$ .00
$ .00
$ .00
Total allocation (equal Line 3 above) $ .00
If you are making an estimated payment enter the amount on Line 2.
This line will NOT update your 2021 total estimated tax liability. If you
anticipate owing $200 or more in municipal income tax, you must
estimate your taxes and make quarterly payments as your income
is earned. If you need to report or update your 2021 Total Estimated
Income Tax enter in Section 1. If your estimated payments are
either less than 90% of the tax due, or not equal to or greater than your
prior year's total tax liability, you will be subject to penalty and
interest.
32
EST-EXT
**See Page 2 for EXTENSION instructions**
RESET FORM
0
0
SECTION 3: EXTENSION OF TIME TO FILE
If you have a copy of your federal extension, you do NOT have to fill out this section.
Check this box if you have not requested or received a federal extension and you are requesting a 6 month
extension to file for the tax year 2020.
If you have requested or received an extension to file your federal income tax return, your municipal income tax
return is extended as well. It is not necessary to file a copy of your federal extension with RITA by the annual
filing due date. Attach a copy of the federal extension when filing your municipal income tax return on or before
the extended due date.
If you have not requested or received a federal income tax filing extension, you may receive a six-
month extension for filing your municipal income tax return by indicating your request in Section 3
above, and submitting this request on or before the filing due date of April 15, 2021.
An extension to file the annual return is not an extension to pay - the tax owed is still due by the annual
filing due date. Please complete Section 2 to pay the tax due for tax year 2020 and the first quarter of
estimated payments due for tax year 2021.
SECTION 4: VERIFICATION
TaxpayerUnder penalties of perjury, I declare that to the best of my knowledge and
belief, the statements
made herein are true and correct.
Your Signature:
Date:
Spouse’s Signature:
Date:
(If filing jointly, BOTH must sign)
Preparer other than taxpayer Under penalties of perjury, I declare that to the best of my knowledge and
belief, the statements made herein are true and correct, that I am authorized by the taxpayer to prepare
this
Declaration and/or Extension.
Signature of Preparer: Date:
Pri
nted Name of Preparer:
May
RITA discuss this Declaration/Extension with the preparer above?
Mail
Declaration/Extension to:
With Payment made payable to RITA: Without Payment:
REGIONAL INCOME TAX AGENCY REGIONAL INCOME TAX AGENCY
P.O. BOX 6600
P.O. BOX 477900
CLEVELAND, OH 44101-2004 BROADVIEW HEIGHTS 44147-7900
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