Individual Municipal Income Tax Drop-Off Sheet
Step 1: General Information
Name: _______________________________________________________________________________________
Current Street Address or P.O. Box Number: ________________________________________________________
City, State and ZIP Code: _______________________________________________________________________
Tax Year: _______________ Social Security Number (Last 4 digits only): XXX-XX-______
Filing status:
Single or married filing separately
Joint Spouse Name: ____________________________ Spouse SSN: XXX-XX-______
Complete if you have moved since January 1, 2020:
Previous Street Address or P.O. Box Number: ____________________________________
City, State, and ZIP Code: ___________________________________________________
Move out date of previous address: ________
Check any of the boxes if the situation applies to you:
You are under 18. Provide Date of Birth: ________ (
include copy of your driver’s license or birth certificate
You are retired. Provide retirement date: ________
Your spouse is retired. Provide Spouse retirement date: ________
You have No Municipal Taxable Income to report for the entire year *
Step 2: Documentation (Documents will NOT be returned)
Include copies of the following documents, in an envelope, if applicable to your situation:
W-2s (include the copies to be filed with Employee’s City or Local Tax Return)
W-2Gs Gambling Winnings (include the copies to be filed with Employee’s City or Local Tax Return)
Schedule C Profit or Loss from Business *
Schedule E Supplemental Income and Loss (includes Rental Income) *
Other Income (1099-NEC/MISC, Schedule F-Profit or
Loss from Farming, 4797 Sales of Business Property Income)*
* Include first two pages of your Federal Form 1040 and Schedule 1.
Signature ___________________________________________________ Date:
May RITA call you if there are questions?
Yes No Contact Phone Number: _______________
Put this sheet with your tax documents in an envelope and drop-off at:
Cleveland Heights
Cleveland Heights City Hall **
40 Severance Circle
Cleveland Heights, OH 44118
Xenia Administration Building **
107 E. Main Street
Xenia, OH 45385
We are providing drop-off service as a contact-free option
to traditional in-person assistance. If you would like
RITA to prepare your return for you, fill out this sheet,
attach your tax documents and drop it off at
select RITA locations.
10107 Brecksville Road
Brecksville, OH 44141
760 Lakeview Plaza Blvd #400
Worthington, OH 43085
Save a trip? Mail this sheet
and your tax documents to
the following address:
PO Box 477900
Broadview Heights, OH
Mentor Municipal Center *
8500 Civic Center Boulevard
Mentor, OH 44060
2761 Salt Springs Road
Youngstown, OH 44509
* Located inside - 1st Floor Lobby (Available 8:00 am - 5:00 pm, Monday-Friday)
** Located outside City Hall, beside utility payment box