Income Tax 1%

SDMS US EPA REGION V COLOR - RESOLUTION - 3 IMAGERY INSERT FORM Multiple pages of this document include color or resolution variations and may be illegible in SDMS due to bad source documents. Unless otherwise noted, these pages are available in monochrome. (The source document page(s) are more legible than the images.) The original document is available for viewing at the Superfund Records Center. SITE NAME CHEMICAL RECOVERY DOC ID # 147464 DOCUMENT COLOR OR X RESOLUTION VARIATION PRP RMD - CHEMICAL RECOVERY PHASE ENFORCEMENT OPERABLE UNITS LOCATION Box# Folder # Subsection PHASE Remedial Removal Deletion Docket (AR DOCUMENTS ONLY) Original Update # Volume of COMMENT(S) FOLDER M-32 REGIONAL INCOME TAX AGENCY RECONCILIATION OF RETURNS FORM 17 P.O. BOX 7777 Of Income Tax Withheld (Form 11) INDEPENDENCE, OHIO 44131 With Forms W-2 Submitted Herewith 1. Total Number of Emptdyeas 20 3. Total Income Tax Withheld from compensation during Total Number of W-2 Formt Eiwtoead 20 I9?4>as shown by form 11 for the period: JANUARY ••"100,56 JULY J2 FEBRUARY —JStsIiL 1.23.86 |s 12-03-75 01-3 L- ft) •MARCH > 89.78 •aCPTBHl.C.. __________ I Federal Employer APRIL 80 ~Q7 OCTOBER 136.11 3 A 0 4 2 0 a 8 <t [Identification No. MAY 106.15 NOVEMBER 113.46 •JUNE $__2a*flB__«DECEMBER *• 132.15 4. Thh total should equal 1% oMine 2 i 77-; o« CHEMICAL kECQVERY SYSTEMS •xBtptCuyahogaHtt.andShdiwHtv TOTAL $ ill infif r*f? 1*2 LOCUST ST PO BOX 375 *lf quarterly payments were made, monthly breakdown not ELYftlA QH 44035 required. Explain fully any discrepancy on back of this form. TAXPAYER'S COPY 1/13/76 signeture Preside nt Title ^M, /<>(>./$• 134, // OFFICE USE ONLY P S____..______ EMPLOYER'S MUNICIPAL TAX WITHHOLDING STATEMENT I S ____.______ REGIONAL INCOME TAX AGENCY T S_________ 5755 GRANGER ROAD INDEPENDENCE, OHIO 44131 INSTRUCTIONS ON REVERSE SIDE I HAVE EXAMINED THIS RETURN AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT. THIS FORM MUST BE RETURNED WITH REMITTANCE! MAKE CHECKS PAYABLE TO R.I.T.A. MAIL TO: R.I.T.A. IXE DATE Form 11 P. O. BOX 6600-T 1975 CLEVELAND, OHIO 44101 R.I.T.A. CI7 v WHERE LOCATED MONTHLY RETURN XX QUARTERLY RETURN D LINES 1,2 AND 4 MUST BE COMPLETED £ LU 1. TOTAL WAGES SUBJECT TO _|CC WITHHOLDING TAX f <§ 2. AMOUNT OF TAXES WITHHELD $. 3. ADJUSTMENTS FOR PREVIOUS MAKE ALL CHANGES ABOVE MONTHS OF CALENDAR YEAR $. DO NOT CROSS OUT INCORRECT INFORMATION (EXPLAIN ON BACK OF FORM) 4. BALANCE DUE ANDPAID HEREWITH $. ill.11 •DISTRIBUTE BELOW DISTRIBUTION OF EMPLOYER'S MUNICIPAL TAXES WITHHELD BASED ON CITY WHERE WORK PERFORMED CODE MUNICIPALITY RATE- AMOUNT CODE MUNICIPALITY RATE* AMOUNT 010 AURORA 485 MAYFIELD VILLAGE 020 AVON 500 MIDDLEBURG HTS 040 BAY VILLAGE 520 MORELAND HILLS 060 BEDFORD 540 NEWBURGH HTS 090 BENTLEYVILLE 550 NORTH OLMSTED 100 BEREA 565 NORTH RIDGEVILLE 130 BRECKSVILLi; 580 OAKWOOD 140 BROADVIEW HTS 590 OLMSTED FALLS 160 BROOKLYN HTS 600 ORANGE 180 CHAGRIN FALLS 650 PEPPER PIKE 210 CLEVELAND HTS 660 REMIIMDERVILLE 250 CUV AHOGA HTS .50% 670 RICHMOND HTS 270 EAST CLEVELAND 720 SEVEN HILLS 277 ELYRIA It $132.15 750 SHAKER HTS 300 FAIRVIEW PARK 752 SHEFFIELD VILLAGE 320 GARFIELD HTS 770 SOUTH EUCLID 370 HIGHLAND HTS 775 STREETSBORO 385 HURON 780 STRONGSVILLE 390 INDEPENDENCE 800 UNIVERSITY HTS 400 LAKE WOOD 810 VALLEY VIEW 440 LYIVDHURST 820 WALTON HILLS 460 MAPLE HTS 840 WESTLAKE 480 MAVFIELD HTS 900 WOODMERE ALL TAX RATES ARE 1% UNLESS OTHERWISE INDICATED. DO NOT ADD CITIES INSTRUCTIONS FOR COMPLETING EMPLOYER'S MUNICIPAL TAX WITHHOLDING STATEMENT (FORM 11) FOR R.I.T.A. MUNICIPALITIES It is required that on or before the last day of each month, the taxes withheld in the previous month be paid and Form 11 filed with R.I.T.A. However, if the amount withheld in any one month-tor a.municipality is.less thar>,$jp0,00, the employer may defer the filing of Form 11 and the payment of the amount withheld until the last day of the month following the end of the calendar quarter. Please check the appropriate box on the front of Form 11 to designate whether this is a monthly or quarterly return. 1. Place the amount of total wages, salaries, commissions, etc., subject to withholding tax for R.I.T.A. municipalities on iine 1 of Form 11. 2. Place the amount of municipal taxes withheld for the period on line 2. 3. If you have any adjustments to the municipal taxes you have reported for the previous months of this calendar year, then place those adjustments on line 3 of Form 11. Also print on the back of Form 11 the reason for the adjustments or attach a printed or typewritten letter. 4. Subtract line 3 from line 2 and place that amount on line 4 of Form 11. This is the amount of tax due. List the amount of taxes for each municipality next to the name of the municipality where the taxes are due. " PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO R.I.T.A. ENCLOSE CHECK OR MONEY ORDER AND ORIGINAL COPY OF FORM 11 IN THE ENCLOSED RETURN ENVELOPE. RETAIN DUPLICATE COPY OF FORM 11 FOR YOUR RECORDS. If you have any questions regarding the completion of this form, please call 398-8400. CHANGES If your mailing address, company name, trade name or R.I.T.A. city where located is incorrect or has changed from that shown on Form 11, enter all changes on the form next to the information that has changed. EXPLANATION OF LINE 3 ADJUSTMENTS: OFFICE USE P S_____ EMPLOYER'S MUNICIPAL TAX WITHHOLDING STATEMENT I $ _______ REGIONAL INCOME TAX AGENCY T $______ 5755 GRANGER ROAD INDEPENDENCE, OHIO 44131 INSTRUCTIONS ON REVERSE SIDE I HAVE EXAMINED THIS RETURN AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT. THIS FORM MUST BE RETURNED WITH REMITTANCE MAKE CHECKS PAYABLE TO R.I.T.A. MAIL TO: R.I.T.A. ^•GNATURE TITLE DATE —————— Form 11 P. O. BOX 6600-T 1975 CLEVELAND, OHIO 44101 R.I.T.A. Cl TV WHERE LOCATED MONTHLY RETURN XK QUARTERLY RETURN D LINES 1,2 AND 4 MUST BE COMPLETED _ 1. TOTAL WAGES SUBJECT TO _icr WITHHOLDING TAX $u <§ 2 AMOUNT OF TAXES WITHHELD $. 3. ADJUSTMENTS FOR PREVIOUS MAKE ALL CHANGES ABOVE MONTHS OF CALENDAR YEAR $. DO NOT CROSS OUT INCORRECT INFORMATION (EXPLAIN ON BACK OF FORM) 4. BALANCEDUE AND PAID HEREWITH $. it* 'DISTRIBUTE BELOW DISTRIBUTION OF EMPLOYER'S MUNICIPAL TAXES WITHHELD BASED ON CITY WHERE WORK PERFORMED CODE MUNICIPALITY RATE* AMOUNT CODE MUNICIPALITY RATE" AMOUNT 010 AURORA 485 MAYFIELD VILLAGE 020 AVON 500 MIDDLEBURG HTS "~ 040 BAY VILLAGE 520 MORELAND HILLS 060 BEDFORD 540 NEWBURGH HTS 090 BEMTLEYVILLE 550 NORTH OLMSTED 100 BE Pi E A 565 NORTH RIDGEVILLE 130 BRECKSVILLE 580 OAKWOOD 140 BROADVIEWHTS 590 OLMSTED FALLS 160 BROOKLYN HTS 600 ORANGE 180 CHAGRIN FALLS ^650 PEPPER PIKE 210 CLEVELAND HTS 660 REMINDERVILLE 250 CUYAHOGA HTS .50% 670 RICHMOND HTS 270 EAST CLEVELAND 720 SEVEN HILLS 277 ELYRIA 11 $113.46 750 SHAKER HTS 300 ...FAIRVIEWPAflK 752 SHEFFIELD VIJ.LAGE 320 GARFIELD HTS 770 SOUTH EUCLID 370 HIGHLAND HTS 775 STREETSBORO 385 HURON 780 STRONGSVILLE 390 INDEPENDENCE 800 UNIVERSITY HTS 400 LAKEWOOD 810 VALLEY VIEW 440 LYNDHURST 820 WALTON HILLS 460 MAPLE HTS 840 WESTLAKE 480 MAYFIELD HTS 900 WOODMERE ' ALL TAX RATES ARI- 1 % UNLESS OTHERWISE INDICATED. DO NOT ADD CITIES OFFICE USE ONLY P S___..__.._._ EMPLOYER'S MUNICIPAL TAX WITHHOLDING STATEMENT REGIONAL INCOME TAX AGENCY T $ __________. 5755 GRANGER ROAD INDEPENDENCE, OHIO 44131 INSTRUCTIONS ON REVERSE SIDE I HAVE EXAMINED THIS RETURN AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT | THIS FORM MUST BE RETURNED WITH REMITTANCE MAKE CHECKS PAYABLE TO R.I.T.A. MAIL TO: R.I.T.A. SIGNATURE 5 TITLE DATE Form 11 F P. O. BOX 6600-T 1975 CLEVELAND, OHIO 44101 R.I.T.A. CITY WHERE. LOCATED MONTHL Y RETURN X QUARTERL Y RETURN a LINES 1,2 AND 4 MUST BE COMPLETED ig 1 TOTAL WAGES SUBJECT TO WITHHOLDING TAX $—13 2. AMOUNT OF TAXES WITHHELD S. 3. ADJUSTMENTS FOR PREVIOUS MAKE ALL CHANGES ABOVE MONTHS OF CALENDAR YEAR $. DO NOT CROSS OUT INCORRECT INFORMATION (EXPLAIN ON BACK OF FORM) 4. BALANCEDUE AND PAID HEREWITH $. lift.11 'DISTRIBUTE BELOW * DISTRIBUTION OF EMPLOYER'S MUNICIPAL TAXES WITHHELD BASED ON CITY WHERE WORK PERFORMED CODE MUNICIPALITY RATE* AMOUNT CODE MUNICIPALITY RATE* AMOUNT 010 AURORA 485 MAYFIELD VILLAGE 020 AVON 500 MIDDLEBURG HfS 040 BAY VILLAGE 520 MORELAND HILLS 060 BEDFORD 540 NEWBURGH HTS 090 BENTLEYVILLE 550 NORTH OLMSTED 100 BEREA 565 NORTH RIDGEVILLE 130 BRECKSVILLE 580 OAKWOOD 140 BROADVIEW HTS 590 OLMSTED FALLS 160 BROOKLYN HTS 600 ORANGE 180 CHAGRIN FALLS 650 PEPPER PIKE 210 CLEVELAND HTS 660 REMINDERVILLE 250 CUYAHOGA HTS .50% 670 RICHMOND HTS 270 EAST CLEVELAND 720 SEVEN HILLS 277 ELYRIA 750 SHAKER HTS ft $136-11 300 FAIRVIEWPARK 752 SHEFFIELD VILLAGE "320 GARFIELDHTS 770 SOUTH EUCLID 370 HIGH LAND HTS 775 STREETSBORO 385 HURON 780 STRONGSVILLE 390 INDEPENDENCE 800 UNIVERSITY HTS 400 LAKE WOOD 810 VALLEY VIEW 440 LYNDHURST 820 WALTON HILLS 460 MAPLE HTS 840 j WESTLAKE 480 MAVFIELD HTS 900 WOODMERE ALL TAX RATES ARE 1% UNLESS OTHERWISE INDICATED. DO NOT ADD CITIES OFFICE I'SE ONLY p :; ___ __.__ EMPLOYER'S MUNICIPAL TAX WITHHOLDING STATEMENT I H ____. ___.___ REGIONAL INCOME TAX AGENCY T S___________ 5755 GRANGER ROAD INDEPENDENCE, OHIO 44131 INSTRUCTIONS ON REVERSE SIDE I HAVE EXAMINED THIS RETURN AND TO THE BEST OF MY KNOWLEDGE IT IS CORRECT.

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