FormPRINT FORM37RESET FORMRegional Income Tax AgencyRITA Individual Income Tax ReturnOPEN BLANK FORMContact us toll free:Cleveland800.860.7482Columbus866.721.7482Youngstown866.750.7482TDD440.526.53322013Your social security numberSpouse’s social security numberYour first name and middle initialLast nameIf a joint return, spouse’s first name and middle initialLast nameFiling Status:Single or Married Filing Separately 3Joint 21If you have an EXTENSION check here andattach a copy:EXTENSIONHome address (number and street)If this is an amended return, check here:Apt #City, state, and ZIP codeRITA’s eFileDaytime phone numberEasy, Fast, Free & Securewww.ritaohio.comEvening phone numberMove InformationCheck here if you moved since January 1, 2013, and indicate your change of address. If you moved more than once, supply theadditional move information on a separate sheet.Date of Move:Current Address (number and street)CityStateZipPrior Address (number and street)CityStateZipSection AList all W-2 wages earned in 2013 and the amount of municipal (city) tax withheld while living in a RITA municipality. In general, unless youmoved into or out of a RITA municipality during the year, your taxable wages cannot be less than Medicare wages (Box 5 of your W-2). List alltax withheld to your resident municipality in Column 3 only (even if you worked in the municipality where you lived). In Column 4, indicate thename of the municipality in which you or your spouse physically worked. This may be different from the employer’s address shown on theW-2. If you did not work in a city or village enter “None” in Column 4. DO NOT enter school district tax into columns 2 or 3.Column 2Local/City TaxWithheld forWorkplaceMunicipalityPaperclip Local/City copy of W-2 Formsand Check or Money Order HereDo not use staples, tape or glueColumn 1Wages(Greater of Box 1,5 or 18 from W-2)TotalsCaution0Column 3Local/City TaxWithheld forResidentMunicipalityColumn 4Column 5Workplace Municipality(Name of city or villagewhere you worked)Resident Municipality(Name of city or villagewhere you lived)Column 6Dates Wages WereEarnedFrom DateThru DateMM/DD/YYMM/DD/YYEnter the total of Column 1 on Page 2, Line 1a; enter the total of Column 200 on Page 2, Line 4a; and enter the total of Column 3 on Page 2, Line 7a.To manually calculate your taxes please continue to page 2. Tax balances are due by April 15th, 2014. Submitting an incomplete formcould subject you to penalty and interest if a tax balance is due. If you want RITA to calculate your taxes, please use the online eFilesystem at www.ritaohio.com. It is easy to use, secure and will calculate your taxes immediately.Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, andaccurately lists all amounts and sources of municipal taxable income I received during the tax year.Your SignatureSpouse’s Signature if a joint returnDatePreparer’s SignatureDateDatePreparer’s AddressID NumberMay RITA discuss this return with the preparer shown above?YesNoPreparer Phone #:Filing is mandatory for most residents: see “Filing Requirements” on page 1 of the Instructions for Form 37 exemptions.Page 2Form 37 (2013)Section BWithheldtaxesshown onyour W-2forms arereported oneither line 4aor 7a.1 a Total W-2 wages from Page 1, Section A, Column 11ab Total self-employment, rental, partnership, and (if applicable)S corporation income as well as any other taxable income fromPage 3, Schedule J, Line 31. If less than zero enter -01b22Total taxable income. Add lines 1a and 1b3Multiply Line 2 by the tax rate of your resident municipality from the tax table.Enter the tax rate of your resident municipality here:%4 a Tax Withheld for all municipalities other than your municipality of residencefrom Page 1, Section A, Column 2. Do not enter estimated tax payments4ab Direct payment from Page 3, Schedule K, Line 35. Do not: enter taxwithheld from your wages and or estimated tax payments on this line 4b5 a Add lines 4a and 4b5ab Total tentative credit from Credit Rate Worksheet, Column E located at the5bbottom of this page. Your resident municipality’s credit rate:c Enter the smaller of line 5a or line 5b5cMultiply Line 5c by the credit factor of your resident municipality from6the tax table. Your resident municipality’s credit factor:67 a Tax withheld for your resident municipality from Page 1, Section A,7aColumn 3. Do not enter estimated tax payments. (see instructions)b Tax paid by your partnership/S corp to any RITA municipality7b8Total credits allowable. (Add lines 6, 7a, and 7b)9Subtract Line 8 from Line 39101112Refunds:To avoiddelays inprocessingyour refund,mail yourreturn to thePO BOXaddresslisted in lowerright handcorner of thispage.13Refunds oftax withheldfrom yourwages mustbe appliedfor on Form10A.1819DownloadForm 10A atwww.ritaohio.com14151617Tax on non-withheld wages from Page 3, Schedule K, Line 3210Tax on Schedule J Income from Page 3, Schedule K, Line 3611TAX DUE RITA AFTER WITHHOLDING. Add lines 9, 10 and 11. If less than zero, enter-0- and file Form 10A (see instructions)2013 Estimated Tax Payments made to RITA by check, debit orcredit card or ePayment. Do not enter tax withheld from your W-2s.13Only include payments made for the 2013 tax year.Credit carried forward from 201214TOTAL CREDITS. Add lines 13 and 14Balance Due. If line 15 is less than line 12, subtract line 15 from line 12.Amounts less than $1 will not be collected.If line 15 is GREATER than 12, subtract line 12 from line 15 and enter OVERPAYMENTAmount you want credited to your 2014 estimated taxAmount to be refunded. You may not split an overpaymentbetween a refund and a credit. Allow 90 days for your refund.20 a Enter 2014 estimated tax in full (see instructions). Estimates aredue 4/15/14, 7/31/14, 10/31/14 and 1/31/15b Enter full estimate or first quarter estimate (1/4 of line 20a)21Subtract line 18 from line 20bTOTAL DUE by April 15, 2014. Add Lines 16 and 21223812151617181920a20b2122Estimated Taxes (Line 20a)If you anticipate owing $10 or more in income tax in 2014, you must estimate your taxes and make quarterly payments of the anticipated tax due asyour income is earned. See the RITA Member list at www.ritaohio.com for detailed municipality information regarding exceptions to the $10 rule.If your estimated taxes are not 90% of the tax due or not equal to or greater than your prior year’s total tax liability, you may be subject to penalty andinterest. You may use the amount on Line 12 as your 2014 estimate or use Worksheet 2 in the instruction booklet to calculate your estimate.Credit Rate Worksheet: (applies to Section A wages and Schedule J, Line 29 income)ABCWages/IncomeCredit RateMaximum creditearned outside of for resident municipality (multiply column Aresident municipalityfrom tax tableby column B)DWorkplace taxwithheld/paidTotal Tentative Credit. Enter on Section B, Line 5b above.ETentative CreditEnter lesser ofcolumns C or DMail your return with W-2s anda copy of your federal schedules to:With payment made payable to RITA:Regional Income Tax AgencyPO Box 6600Cleveland OH 44101-2004Without payment:Regional Income Tax AgencyPO Box 94801Cleveland OH 44101-4801Refund with an amount on line 19:Regional Income Tax AgencyPO Box 89409Cleveland OH 44101-6409A COPY OF ALL APPROPRIATE FEDERAL SCHEDULES ARE REQUIRED IF COMPLETING SCHEDULE J.SCHEDULE JPrint the name of eachmunicipality where a profit/(loss) was earned in theappropriate box(es)23.From FederalSCHEDULE C Attached24.From FederalSCHEDULE E Attached*25.All Other Taxable IncomeSUMMARY OF NON W-2 INCOME (For columns 2-5 enter the Municipality where the income was earned)COLUMN 1COLUMN 2COLUMN 3COLUMN 4RESIDENCE MUNICIPALITY NONTAXING MUNICIPALITY RITA MUNICIPALITY OF RITA MUNICIPALITY OFCOLUMN 5TAXED BY ANON-RITA MUNICIPALITY151112131421222324253132333435414243444551) (52) (53) (54)(636465COLUMN 6ADD COLUMNS1, 2, 3, 4 and 5(or Loss). Attach Schedule(s)26. TOTAL NON-WAGEINCOME(Add Lines 23, 24, 25)27. LESS LOSS CARRYFORWARD IF ALLOWABLE28.WORKPLACE INCOME(616255)(Line 26 minus Line 27)29.WORKPLACE INCOME(Line 26 minus Line 27)Column 6, Line 28 or Line 29 cannot beless than zero. If amount is less thanzero, use zero.30.MUNICIPAL TAX DUE(NOTE: Line 30 cannot beless than zero.)TOTAL of Column 6, place the total in Section B, Line 1b. 31.NOTE: If any columns on Line 29 have entries complete Schedule K, Line 34.*S-Corporation Distributions - Special Rules Apply - See the RITA Member List at www.ritaohio.com for detailed municipality information.32.SCHEDULE KTo complete Schedule K, see page 6 of the instructions. If additional space is needed, use separate sheet.W-2 WAGES EARNED IN A RITA MUNICIPALITY OTHER THAN YOUR RESIDENCE MUNICIPALITY FROM WHICHNO MUNICIPAL INCOME TAX WAS WITHHELD BY EMPLOYER. Complete Lines below.Tax RateWagesMunicipality(see instructions)Tax DueEnter total tax due onto Line 32 and in Section B, Line 10.33.32.W-2 WAGES EARNED IN A NON-RITA TAXING MUNICIPALITY AND FROM WHICH NO MUNICIPAL INCOME TAX WASWITHHELD BY EMPLOYER. (ONLY USE THIS SECTION IF YOU HAVE FILED AND PAID THE TAX DUE TO YOURWORKPLACE MUNICIPALITY. PROOF OF PAYMENT MAY BE REQUIRED) Complete Lines Below.Tax RateWagesMunicipalityTax Due(see instructions)Enter total tax due onto Line 3334.TAX DUE TO OTHER THAN RESIDENCE MUNICIPALITY ON NON W-2 INCOME REPORTED IN SCHEDULE J, LINE 29,COLUMNS 3, 4, AND 5. Complete Lines below.Workplace Income(Line 29, Columns 3, 4, & 5)MunicipalityTax Rate(see instructions)33.Tax DueEnter total tax due onto Line 3434.35.TOTAL LINES 32, 33 AND 34. Enter total on Line 35 and in Section B, Line 4b.35.36.FROM SCHEDULE J ABOVE, ADD LINE 30 COLUMNS 3 AND 4. Enter total on Line 36 and in Section B, Line 11.36.