Form 10A PDF Details

The Form 10A, a crucial document managed by the Regional Income Tax Agency, is a comprehensive tool designed for individuals seeking a municipal income tax refund for a variety of reasons. Detailing personal information such as name, social security number, and current address, it requires applicants to specify the tax year for which the claim is being made. The form is notably inclusive, accommodating a wide range of refund claims, from age exemptions and un-reimbursed business expenses to job-related relocations and errors in withholding. Documentation, such as W-2 forms and, in some cases, employer certifications, must accompany claims, validating the circumstances under which a refund is warranted. The Form 10A caters to individuals who have multiple W-2 forms, have performed work outside of the municipality from which a refund is sought, or have experienced discrepancies in tax withholdings due to rate differences or clerical errors. Furthermore, specific categories, including over-the-road truck drivers and those affected by the Military Spouse Residency Relief Act, are provided for within the form, ensuring a broad spectrum of taxpayers can rectify their municipal tax contributions effectively. This adaptability underscores the form's role in addressing the nuanced demands of municipal tax administration, emphasizing accurate tax liability and the right to rectification when overpayments occur.

QuestionAnswer
Form NameForm 10A
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesrita form 10a, rita form 10a tax, form rita 10a pdf, form 10a

Form Preview Example

Form

10A

Regional Income Tax Agency

Application for Municipal Income Tax Refund

Your first name and middle initial

Last name

Your social security number

Tax year of claim

Current home address (number and street)

Apt #

City, state, and ZIP code

Daytime phone number

Evening phone number

Reason for Claim

Check the Box below that applies.

•A separate 10a is required: If you have multiple W-2 forms or for each municipality from which a refund is requested.

•No refunds will be issued without the proper documentation indicated by reason for claim.

Month

Day Year

1.

2.

3.

3.

4.

5.

6.

Age Exemption. Date of Birth:

 

.

Attach a copy of your W-2 Form and proof

of birthdate (birth

certificate, driver’s license, etc).

If you were under 18 for only part of the year, you must either: 1) have your

employer sign the

completed Employer Certification on page 2; or 2) attach a copy of your pay stub for the pay period in which your birthday fell.

Exceptions to the 18 years

of age

or older exemption exist. For more

information,

visit ritaohio.com, select the

RITA municipality in which you

worked

and review the Special Notes section

that relates

to the appropriate tax year.

Un-reimbursed business expenses. For Tax Year 2018, the un-reimbursed employee expense deduction has been eliminated for federal income tax purposes. Tax Year 2018 municipal income tax refunds for this reason are not available for most employees. Qualified performing artists, fee-basis state or local government officials and employees with impairment-related work expenses may claim a refund for this reason. For Tax Year 2017 and prior, attach a copy of your W-2 Form, the federal Schedule A and federal Form 2106 filed with your federal 1040. Employer does NOT need to complete the Employer Certification.

Days worked outside of municipality for which the employer withheld tax. Attach a copy of your W-2 Form, a completed Log of Days Out Worksheet on page 3, and a completed Calculation for Days Worked Out of RITA on page 3. In addition, your employer must complete and sign the Employer Certification Parts 1 and 2 on page 2.

Employer withheld at a rate higher than the municipality’s tax rate. Attach a copy of your W-2 Form. Your employer must complete and sign the Employer Certification Parts 1 and 2 on page 2.

Employer withheld too much (over-withheld) resident municipality tax. Attach a copy of your W-2 Form. Your employer must sign the Employer Certification Part 2 on page 2.

Withheld by mistake for the municipality of when I actually worked in the municipality of .

Attach a copy of your W-2 Form. Your employer must sign the Employer Certification Part 2 on page 2. Indicate the address where you actually worked.

Work Location Street Address

City

State

Zip

 

 

 

 

7.

8.

9.

10.

Over-the-road truck driver. The wages of an interstate trucker regularly assigned to drive in more than one state are only taxable by the trucker’s municipality of residence. Truck drivers assigned to drive in multiple Ohio municipalities only

may be eligible to receive a 90% refund from their principal place of work. Your employer must complete and sign the Employer Certification Part 2 on page 2.

Military Spouse Residency Relief Act. Attach copies of W-2 Form, Form DD 2058, valid military spouse ID card and service member’s most recent LES.

Other (Indicate Reason). Attach W-2 Form and other applicable documentation. Your employer must complete and sign the Employer Certification Parts 1 and/or 2 on page 2.

Refund of overpayment on account If you have already filed Form 37 or are not required to file. Employer certification is not required.

Claim

1 Employer Federal ID #

Employer Name

 

1

2RITAMunicipality for which tax was withheld (from W-2, Box 20).

RITA cannot refund tax withheld to a Non-RITA municipality

2

3Amount of income not taxable. For reason 2 enter your 2106 expenses less the 2% limitation. Enter -0-

for reasons 4 and 5. For all other reasons enter the amount of wages you are claiming are not taxable

3

4 Amount of over withholding claimed (Box A-9 on page 2)

4

 

5Amount of over withholding you want applied as a payment to your individual or joint

account instead of being refunded to you. Enter -0- if you want all of your refund sent to you

5

 

Provide the social security number of the account to which you want SSN of account to be credited

 

 

the amount on line 5 to be credited

 

 

6 Net amount to be refunded. Subtract line 5 from line 4. Amounts $10 or less will not be refunded.

6

 

 

 

Form 10-A

Name of employee shown on page 1

Page 2

Employee’s SSN

Tax Year of Claim

 

 

Employer Certification – Part 1

A.Refund/Credit Calculation

A 1

Total Wages from employee’s W-2 Form

 

 

A-1

 

 

 

 

 

 

 

 

 

 

2

Enter name of municipality for which tax was withheld

A-2

 

 

 

 

 

3

Amount of municipal tax withheld to the municipality indicated on line A-2

 

 

A-3

 

 

 

 

 

 

 

 

4

List the complete address of the municipality where

 

 

 

 

 

 

 

the employee physically performed the work or

 

 

 

 

 

 

 

 

Work location street address

 

 

 

 

 

services. If the employee did not work within the

 

 

 

 

 

 

 

 

 

 

 

 

 

limits of a municipality, skip lines A-5, A-6 and A-7,

 

 

 

 

 

 

 

and enter -0- on line A-8

A-4

City, State, Zip Code

 

 

 

 

5

Enter the amount of municipal taxable wages earned in the municipality

 

 

 

 

 

indicated on line A-4

 

 

A-5

 

 

 

6

Enter the tax rate of the municipality indicated on line A-4

A-6

 

 

 

7

Tax due to municipality where employee physically worked. Multiply line A-5

 

 

 

 

 

by the tax rate on line A-6

 

 

A-7

 

 

 

8

If the municipality indicated on line A-4 is a RITA municipality, enter the amount from line A-7;

 

 

 

otherwise enter -0-

 

 

 

 

A-8

 

9

Amount of over-withheld tax to be refunded or credited. Subtract line A-8 from line A-3.

A-9

 

 

Amounts $10 or less will not be refunded or credited. Enter total on Page 1, line 4.

 

 

 

 

B.Employee’s Home Address

According to our records, this employee’s home address for the period covered by this claim was:

Employee’s Home Street Address

City

State

Zip

C.Employee’s Employment Dates

If the employee is still employed, enter “n/a” as the date of separation.

Date of Hire

Date of Separation

Employer Certification – Part 2

D.Employer Representative’s Explanation of Reason for Refund and Signature

The undersigned employer representative states that during the year referenced above the employer withheld municipal income tax from the above named employee in excess of the employee’s liability as calculated above; that the above referenced employee was employed during the period

referenced above; that the employer has examined this claim for refund in its entirety including any accompanying schedules and statements; and that the employer representative can attest that the information reported on this claim is true and accurate.

In addition, the undersigned employer representative verifies that no portion of the over-withheld tax has been or will be refunded directly to the employee by the employer, and that no adjustments to the employer’s withholding account related to this claim have been or will be made.

Representative’s Signature

 

 

Representative’s Title

 

Date

 

Representative’s Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Representative’s Name

 

 

Print Representative’s Title

 

Explanation of Reason for Refund (example–“taxpayer works from home 4 days”)

Taxpayer’s Signature

Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct and complete. I understand that this information may be released to the tax administrator of the resident or workplace municipality and the Internal Revenue Service. I further understand that if this refund changes my RITA residence tax, an amended return must be filed before the refund will be issued. I also understand that if I have an unpaid balance due, this refund will be applied to that balance due.

Taxpayer’s Signature

 

Date

To avoid delays:

Mail this form along with the required documents indicated under your “Reason for Claim” on page

1 to the address shown at right; and

If filing Form 37, attach the 10A to the completed return and mail them together.

Taxpayer’s Daytime Phone

 

Taxpayer’s Evening Phone

Mail with required documentation to:

Regional Income Tax Agency

PO Box 470638

Broadview Hts. OH 44147-0638

Form 10-A

Page 3

Name of employee shown on page 1

Employee’s SSN

Tax Year of Claim

Calculation of Days Worked Outside of RITA Municipality

1

Total workdays available. If you normally work a 5 day workweek and you worked for your employer for

 

 

the entire year, enter 260 (52 weeks times 5 days). Otherwise, enter the number of days you normally

 

 

worked in a week times the number of weeks worked (cannot exceed 260).

 

1

2

Days not worked. Enter total number of days included on line 1 that you did not work due to holidays,

 

 

personal days, sick days, and vacation days

 

2

3

Total days actually worked. Subtract line 2 from line 1

 

3

 

 

 

4

Days worked out of town. A log of days out, destination and reason for travel must be included (see

 

 

below). For purposes of this refund claim, if you worked in another municipality that has an income tax,

 

 

the wages earned in that municipality are subject to tax in that municipality.

 

4

 

 

 

 

5

Days worked in the municipality for which tax was withheld. Subtract line 4 from line 3

 

5

 

 

 

 

6

Percentage of wages earned in the municipality. Divide line 5 by line 3

 

6

 

 

 

 

7

Total municipal taxable wages. Enter the larger of Box 5 or 18 from your W-2

 

7

 

 

 

 

8

Wages taxable to municipality for which tax was withheld. Multiply line 6 by line 7

 

8

 

 

 

9

Wages not taxable to municipality for which tax was withheld. Subtract line 8 from line 7. Enter

 

 

here and on Page 1, line 3

 

9

10

Amount of over withholding claimed. Multiply line 9 by the tax rate of the municipality

Tax Rate

 

 

 

 

for which tax was withheld. Enter here and on Page 1, line 4

 

10

Log of Days Out

List the names of the municipalities/locations where you worked while traveling, the reason for your travel, and the number of days worked at your travel destination. Your own worksheet is acceptable. Use additional paper if necessary.

Work Location

Reason

# Days

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

 

 

 

6.

 

 

 

 

 

7.

 

 

8.

 

 

9.

 

 

10.

 

 

 

 

 

11.

 

 

12.

 

 

13.

 

 

14.

 

 

15.

 

 

16.

 

 

17.

 

 

18.

 

 

19.

 

 

20.

 

 

Work Location

 

Reason

# Days

21.

 

 

 

22.

 

 

 

23.

 

 

 

24.

 

 

 

25.

 

 

 

 

 

 

 

26.

 

 

 

 

 

 

 

27.

 

 

 

28.

 

 

 

 

 

 

 

29.

 

 

 

30.

 

 

 

 

 

 

 

31.

 

 

 

32.

 

 

 

33.

 

 

 

34.

 

 

 

35.

 

 

 

36.

 

 

 

37.

 

 

 

38.

 

 

 

39.

 

 

 

40.

 

 

 

Total number of days worked out of town

 

 

How to Edit Form 10A Online for Free

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When it comes to fields of this specific PDF, here's what you should do:

1. When filling out the form 10 rita, be sure to complete all of the important fields in their associated form section. This will help to expedite the work, allowing for your details to be processed without delay and correctly.

Writing section 1 of ohio rita form 10a

2. Once your current task is complete, take the next step – fill out all of these fields - Employees Home Street Address, City, State, Zip, C Employees Employment Dates, If the employee is still employed, Date of Hire, Date of Separation, Employer Certification Part D, In addition the undersigned, Representatives Signature, Representatives Title, Date, Representatives Phone Number, and Print Representatives Name with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

ohio rita form 10a writing process shown (part 2)

3. This next segment is fairly straightforward, To avoid delays Mail this form, If filing Form attach the A to, return and mail them together, Mail with required documentation to, and Regional Income Tax Agency PO Box - every one of these fields is required to be filled out here.

Stage # 3 for submitting ohio rita form 10a

It is possible to make errors when filling in the Regional Income Tax Agency PO Box, therefore be sure you look again before you decide to send it in.

4. Filling out Name of employee shown on page, Employees SSN, Tax Year of Claim, Calculation of Days Worked Outside, Total workdays available If you, the entire year enter weeks, Days not worked Enter total, personal days sick days and, Total days actually worked, below For purposes of this refund, Days worked in the municipality, Percentage of wages earned in the, Total municipal taxable wages, Wages taxable to municipality for, and Wages not taxable to municipality is vital in this fourth section - don't forget to don't rush and take a close look at each and every blank!

Writing part 4 in ohio rita form 10a

5. Last of all, the following final segment is what you need to wrap up before submitting the PDF. The fields here include the following: Amount of over withholding, for which tax was withheld Enter, Tax Rate, Log of Days Out, List the names of the, Work Location, Reason, Days, Work Location, Reason, and Days.

ohio rita form 10a completion process shown (part 5)

Step 3: Reread all the details you have inserted in the blank fields and hit the "Done" button. Right after creating a7-day free trial account with us, you will be able to download form 10 rita or send it through email at once. The form will also be accessible via your personal account with all your adjustments. FormsPal guarantees your data confidentiality by using a protected system that in no way saves or distributes any sort of personal information provided. Be confident knowing your paperwork are kept protected any time you work with our services!

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