Fillable Name CCA DIVISION OF TAXATION EMPLOYERS RETURN OF (Fairfield County)

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Name CCA DIVISION OF TAXATION EMPLOYERS RETURN OF (Fairfield County)

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CCA – DIVISION OF TAXATION
205 W SAINT CLAIR AVE
CLEVELAND OH 44113-1503
216.664.2070 800.223.6317
www.ccatax.ci.cleveland.oh.us
Make checks payable to CCA.
4. Adjustments
(explain below)
5. TOTAL TAXES
ALLOCATED
For the period
To
Due on or before:
Emp Code FEDERAL ID # File Code
1. Total Employment Wages
Subject to Withholding
2. Total Employment Taxes
3. Total Residence Taxes
►
►
Signature Title Co. Phone
I have examined this return and to the best of my knowledge, it is correct and complete
Date
Name
Current Address
City State
Zip
Line 1 - Enter the total taxable employment wages as defined in ORC 718. Do not include wages from individuals under the age of 18. Exceptions: Dresden, Frazeysburg, Hamilton,
Montpelier, M
unroe Falls, New Paris
,
Oakwood, Obetz,
Phillipsburg
, Riverside
and
West Alex
andria
hav
e
no
age
limit; Grand River, Rushsylvania and West Milton under the
age of 16; Geneva-On-The-Lake under the age of 15. New Carlisle indviduals 16 and 17 years old who earn $2500.00 or more are subject to the tax.
Line 2 - Enter the amount of employment tax withheld. See employment municipality for tax rate. Allocation of employment tax withheld must be detailed on this form.
Line 3 - Enter the amount of residence tax withheld. Allocation of residence tax must be detailed on this form.
Line 4 - Adjustment of income tax withheld. –Line 4 should be used for the correction of errors made in withholding of income tax from wages paid in prior quarters. Any amount shown
on Line 4 must be explained on this form.
Line 5 - Balance Due / Paid herewith. Make checks payable to the CCA – Division of Taxation. The amount indicated must be paid with the return by the due date indicated and
allocated to the City of Employment unless work is performed in a non-taxing area. Tax withheld in a non-taxing area reverts back to the City of Residence of
the employee.
Signature - Sign, date and enter phone number before returning this form. A return is not considered filed until signed.
Date Due - Monthly filings are due by the 15
th
day of the month following the end of the withholding period. Semimonthly filings are due by the 3
rd
banking day after the 15
th
day of the
withholding period and the 3
rd
banking day after the last day of the withholding period. Quarterly filings are due on or before the last day of the month following the last day of
each calendar quarter.
INSTRUCTIONS
EMPLOYER’S RETURN
OF INCOME TAX WITHHELD
ALLOCATION OF EMPLOYMENT TAX WITHHELD
Final Return
If this is the last withholding report
to be filed with CCA
– Please check the reason below.
No longer conducts Business
in a CCA community.
No longer withholding residence tax
for a CCA community.
No longer has employees but still
conducts Business in a CCA community.
Merged – enter new Federal ID#
Liquidated
Other reason
EXPLANATION OF ADJUSTMENT – Amount
Adjustment for period end
Reason
(allocate below)
►
►
(allocate below)
Ada 1.65 002 Linndale 2 420 Parma Hts. 3 630
Revenue Sharing/JEDD/JEDZ (complete below)
Alger 1 004 Marble Cliff 2 459 Paulding
1.1
640
Barberton 2.25 025 Mentor-on-the-Lake 2 495 Phillipsburg 1.5 659 Butler Co Annex 2 951
Bratenahl 2 120 Montpelier 1.6 517 Riverside 1.5 680 Clayton/Clay 1.5 984
Burton 1 176 Munroe Falls 2.25 533 Rock Creek 1 698 Emerald Park 2.5 993
Clayton 1.5 199 New Carlisle 1.5 534 Rushsylvania 1 702 Gateway 2.5 990
Cleveland 2.5 200 New Madison 1 538 Russells Point 1 703 Cleve/High Hills 2.5 995
Dresden 1 260 New Miami 1.75 539 Seville 1 722 Hamilton - Fairfield I 2 952
Elida .75 276 New Paris 1 541 Shreve 1 755 Hamilton - Fairfield II 2 953
Frazeysburg 1 307 North Baltimore 1 548 South Russell 1.25 772 Hamilton - Fairfield III 2 954
Geneva-on-the-Lake 1.5 347 North Perry Village 1 555 Timberlake 1 788 High Hills/Cleve 2.5 996
Germantown 1.5 348 North Randall 2.75 560 Union 1.5 797 IX Center 2.5 992
Grand Rapids 1 356 Norton 2 575 Warrensville Hts. 2.6 830 Prairie Obetz 2.5 981
Grand River 2 357 Village of Oakwood 1 585 Waynesfield 1 833 Shaker Sq 2.5 994
Hamilton 2 365 Obetz 2.5 587 West Alexandria 1 834 Warr Hts/Cleve 2.6 997
Highland Hills 2.5 371 Orwell 1.5 605 West Milton 1.5 835
C of C 120-102 03/2020
ALLOCATION OF EMPLOYMENT AND RESIDENCE TAX REMITTED
MUST BE COMPLETED TO AVOID PENALTY
(PSOR\HUVZKLFKZLWKKROGPRUHWKDQSHUPRQWKPXVW¿OHPRQWKO\
(PSOR\HUVDOZD\VZLWKKROGLQJRUOHVVSHUPRQWKFDQ¿OHTXDUWHUO\
North Baltimore 1 988
Clear Form
Validate Form
(allocate below)
(allocate below)
(explain below)
$0.00
$0.00
$0.00
$0.00
$0.00
ALLOCATION OF RESIDENCE TAX WITHHELD
GENERAL INSTRUCTIONS FOR FORM CCA – 102
Municipality
Code
Tax Withheld Municipality
Code
Tax Withheld Municipality
Code
Tax Withheld
Ada 002 Marble Cliff 459 Phillipsburg 659
Alger 004 Mentor-on-the-Lake 495 Riverside 680
Barberton 025 Montpelier 517 Rock Creek 698
Bratenahl 120 Munroe Falls 533 Rushsylvania 702
Burton 176 New Carlisle 534 Russells Point 703
Clayton 199 New Madison 538 Seville 722
Cleveland 200 New Miami 539 Shreve 755
Dresden 260 New Paris 541 South Russell 772
Elida 276 North Baltimore 548 Timberlake 788
Frazeysburg 307 North Perry Village 555 Union 797
Geneva-on-the-Lake 347 North Randall 560 Warrensville Hts. 830
Germantown 348 Norton 575 Waynesfield 833
Grand Rapids 356 Village of Oakwood 585 West Alexandria 834
Grand River 357 Obetz 587 West Milton 835
Hamilton 365 Orwell 605
Highland Hills 371 Parma Hts. 630
Linndale 420 Paulding 640
Total Residence Tax
Ź
C of C 120-102 03/2020
WHO MUST FILE – Employers doing business within any CCA community with one or more employees must le and pay employment tax as de
ned in ORC 718.
If you temporarily discontinue paying wages, you must nevertheless le a return with CCA. If you no longer expect to pay wages subject to the tax reportable on this form, you must
le a ‘FINAL RETURN’ with explanation shown below. After you have once led a return, a preprinted Form CCA-102 will be mailed to you. Blank forms can also be downloaded at
www.ccatax.ci.cleveland.oh.us. Remit timely and complete all necessary information in order to avoid penalty.
WHAT INCOME IS TAXABLE – Qualifying wages as dened in ORC Section 718. (Typically, FICA/Medicare wages are reportable in Box 5 of Federal Form W-2 with two possible
additions for stock options and sub pay.)
PENALTY & INTEREST – The law provides penalties for late ling of a return and payments thereof. Penalties also are imposed by law for failure to pay, for making false or fraudulent
returns or for submitting bad checks. Each return led and/or paid past the due date may incur a 50% penalty. Interest on the upaid balance may accrue monthly using the interest
prescribed in ORC 718. See community ordinances for variances.
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Name CCA DIVISION OF TAXATION EMPLOYERS RETURN OF (Fairfield County)

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Completed 14 January 2021

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