WITHHOLDING AND BUSINESS REGISTRATION
CCA - MUNICIPAL INCOME TAX
If registration is for individuals, you must complete the
Individual Taxpayer Registration form.
Field/sections marked with an asterisk (
*
) are
Required
CCA Business Registration Details
*
Date Business Started
in CCA Community
Business Type
SOLE PROPRIETOR**
CORPORATION
ENTERTAINMENT
ESTATE OR TRUST
FINANCIAL ORG.
GOVERNMENTAL
LIMITED LIABILITY CO
NON-PROFIT ORG
PARTNERSHIP
PUBLIC UTILITY
S_CORPORATION
SPORTS
UNION
OTHER
Sole Proprietor SSN
Federal ID No (FEIN)
Officer's Name
Owner's Name
Business/Corporate Name
DBA
Principal Business Code
Select Industry
3291 Abrasive products
6321 Accident & health insurance
8721 Accounting, auditing & bookkeeping
7929 Actors, musicians, & entertainers
2891 Adhesives & sealants
7322 Adjustment & collection services
0096 Adm of Economic Programs
0094 Administration of Human Resources
7311 Advertising agencies
0001 Agricultural Production - Crops
0002 Agricultural Production - Livestock
0007 Agricultural Services
3563 Air & gas compressors
4513 Air courier services
9511 Air, water & solid waste management
3721 Aircraft
3724 Aircraft engine parts
3728 Aircraft equipment, wings & landing gear
4581 Airports & hanger services
2812 Alkalies & chlorine
3363 Aluminum die-castings
3354 Aluminum extruded products
3365 Aluminum foundries
3334 Aluminum primary production
3355 Aluminum rolling & drawing
3353 Aluminum sheet, plate & foil
3483 Ammunition, except for small arms
0079 Amusement & Recreation Svcs
3599 Amusement park rides, flexible metal hose, etc.
7996 Amusement parks
0273 Animal aquaculture
0752 Animal services, except veterinary
0279 Animal specialties
0742 Animal veterinary services
2077 Animal/marine fats/oils
1231 Anthracite mining
6513 Apartment building operators
0056 Apparel and Accessory Stores
0023 Apparel/Other Textile Products
3699 Arc welders, speakers & security systems
7993 Arcade machines & jukeboxes
8712 Architectural services
7694 Armature rewinding shops
3292 Asbestos products
2952 Asphalt felts & coatings
2951 Asphalt paving
3949 Athletic & sporting goods
7536 Auto glass replacement
0075 Auto Repair/Services/Parking
7549 Auto services exc repair/carwash
5531 Auto supply stores
7537 Auto transmission repair
2396 Auto trim, linings and findings
3822 Automatic environmental controls
7533 Automobile exhaust repair
7521 Automobile parking
5012 Automobiles, trucks, RVs & motorcycles
0055 Automotive Dealers & Service Stations
5013 Automotive equipment
3465 Automotive stamping
2399 Badges, pet toys, flags, hammocks, etc.
3562 Ball & roller bearings
6719 Bank holding companies
6712 Bank holding companies offices
7241 Barber shops
5813 Bars & night clubs
3568 Bearings, bushings, couplings & chain drives
7231 Beauty shops
0211 Beef cattle feedlots
0212 Beef cattle, except feedlots
5181 Beer & ale
2063 Beet sugar
2387 Belts
0171 Berry crop farming
2836 Biological products
1221 Bituminous & lignite surface mining
1222 Bituminous coal underground mining
3312 Blast furnaces & steel mills
3564 Blowers & fans
3732 Boat building & repairing
5551 Boat dealers
4499 Boat rentals, cleaning & salvage services
3452 Bolts, nuts, rivets & washers
2732 Book printing
2731 Book publishing
5942 Book stores
2789 Bookbinding
5192 Books, magazines & newspapers
3131 Boot & shoe soles, heels & parts
5984 Bottle gas dealers
7933 Bowling alleys
2342 Bras & girdles
2051 Bread products exc cookie/crkr
3251 Brick & structural clay tile
5032 Brick, stone & construction materials
1622 Bridges, tunnels & elevated highways
3991 Brooms & brushes
7349 Building cleaning & maintenance services
0052 Building Materials and Garden
3995 Burial caskets
4142 Bus charter service, except local
8244 Business & secretarial schools
8611 Business associations
8748 Business consulting services
0073 Business Services
3965 Buttons, fasteners, pins & needles
4841 Cable & pay TV
3578 Calculators, adding machines & bank machines
5946 Camera & photo supply stores
2091 Can/cure fish & seafoods
4449 Canal freight transport
2064 Candy & other products
5441 Candy stores
2061 Cane sugar exc refining
2062 Cane sugar refining
2033 Canned preserves/jams/jellies
2032 Canned specialties
2394 Canvas
3675 Capacitors
3647 Car lights & mounted spotlights
3624 Carbon & graphite products
2895 Carbon black
3955 Carbon paper & inked ribbon
3592 Carburetors, pistons & valves
2631 Cardboard mills
4789 Cargo loading, passenger trains, horses, etc.
1751 Carpentry work
7217 Carpet & upholstery cleaning
2273 Carpets & rugs
7542 Carwashes
0119 Cash grains farming
5961 Catalog & mail order houses
6553 Cemetery subdividers & developers
6019 Central reserve depository
3253 Ceramic wall & floor tile
2043 Cereal breakfast foods
6099 Check cashing agencies
2022 Cheese
1479 Chemical mineral mining, including fertilizers
2899 Chemical preparations
5169 Chemical products
0028 Chemicals and Allied Products
2067 Chewing gum
2131 Chewing tobacco, pipe tobacco & snuff
0252 Chicken eggs
8351 Child day care services
5641 Children's clothing stores
2361 Childrens dresses
2369 Childrens outerwear
3261 China plumbing fixtures
3262 China table & kitchen ware
8041 Chiropractor's offices
2066 Chocolate & cocoa products
2111 Cigarettes
2121 Cigars
2257 Circle knit fabric mills
0174 Citrus fruits groves
8641 Civic, social & fraternal organizations
1459 Clay & refractory minerals
3255 Clay refractories
3589 Cleaning, sewage & food cooking & warming equipment
2393 Cloth bags
5052 Coal & other minerals
0012 Coal Mining
1241 Coal mining services
2671 Coated and laminated paper packaging
2672 Coated and laminated paper, including sandpaper
2295 Coated fabric, except rubber
7215 Coin-operated laundries
2999 Coke, fuel briquettes & waxes
3316 Cold-rolled steel
8221 Colleges, universities & professional schools
4939 Combination utilities
9131 Combined executive & legislative offices
7336 Commercial art & graphic design
8732 Commercial economics & educational research
5046 Commercial equipment
2754 Commercial gravure printing
3646 Commercial lighting fixtures
2752 Commercial lithographic printing
7335 Commercial photography
8731 Commercial physical & biological research
2759 Commercial printing, miscellaneous
9641 Commodities & agricultural marketing regulation
6221 Commodity brokers & dealers
6799 Commodity investors
0048 Communication
5734 Computer & software stores
7376 Computer facilities management services
7373 Computer integration & systems design
7378 Computer maintenance & repair
3577 Computer printers, plotters & scanners
7371 Computer programming services
7379 Computer related services
7377 Computer rental
3572 Computer storage devices
3575 Computer terminals
3571 Computers
5045 Computers & software
3272 Concrete basins, fireplaces, monuments, etc.
3271 Concrete blocks & bricks
1771 Concrete work
5145 Confectionery groceries
5082 Construction & mining machinery
3531 Construction machinery
5039 Construction materials
1442 Construction sand & gravel
5731 Consumer electronics stores
3535 Conveyors
2052 Cookies & crackers
3366 Copper foundries
1021 Copper ores
3351 Copper rolling & drawing
3331 Copper smelting & refining
2298 Cordage & twine
0115 Corn farming
9223 Correctional institutions
2653 Corrugated paper boxes
2844 Cosmetics
3961 Costume jewelry
0131 Cotton farming
0724 Cotton ginning
2211 Cotton weaving mills
2074 Cottonseed oil mills
4215 Courier services, except air
9211 Courts
2021 Creamery butter
7323 Credit reporting services
0722 Crop machine harvesting services
0721 Crop planting & cultivating
0723 Crop preparation, except cotton gins
3466 Crowns & closures
1311 Crude oil & natural gas
4612 Crude petroleum pipeline
1423 Crushed, broken granite
1422 Crushed, broken limestone
1429 Crushed, broken stone
2391 Curtains & draperies
3281 Cut stone
3421 Cutlery
2865 Cyclic crudes & dyes
0241 Dairy farming
5143 Dairy products
7911 Dance studios
8243 Data processing schools
7374 Data processing services
0175 Deciduous tree fruit orchards
2395 Decorative stitching
3843 Dental equipment
8072 Dental laboratories
8021 Dentist's offices
5311 Department stores
0060 Depository Institutions
7381 Detectives, guards & armored cars
2675 Die-cut paper
1411 Dimension stone
7331 Direct mail advertising
5963 Direct sales establishments
7342 Disinfecting & exterminating services
3823 Display & control instruments
2085 Distilled liquor, except brandy
8011 Doctor's offices
2047 Dog & cat food
3942 Dolls & stuffed toys
4424 Domestic freight sea transport
5714 Drapery & upholstery stores
2034 Dried fruits/veggie/soup mixes
1381 Drilling oil & gas wells
7833 Drive-in movie theaters
5912 Drug stores
5122 Drugs, cosmetics & toiletries
3582 Dry cleaning and pressing equipment
7216 Drycleaning plant, except rugs
0058 Eating and Drinking Places
5812 Eating places
9411 Educational programs administration
0082 Educational Services
4911 Electric companies
3634 Electric housewares & fans
3641 Electric lamps & bulbs
3629 Electric power industry equipment
4931 Electric, combined with other services
0049 Electric/Gas/Sanitary Svcs
5064 Electrical appliances
5063 Electrical equipment & wiring
7629 Electrical repair shops
1731 Electrical work
3825 Electricity testers
3845 Electromedical therapy apparatus
3313 Electrometalurgical products
3671 Electron tubes & cathode ray tubes
0036 Electronic & Electric Equipment
3679 Electronic components
3678 Electronic connectors
5065 Electronic parts
3471 Electroplate/polish/color
3479 Electroplating, polishing & coloring
8211 Elementary & secondary schools
3534 Elevators & escalators
3669 Emergency alarms & traffic lights
3431 Enameled iron/metal ware
3694 Engine electronic equipment
0087 Engineering & Management Services
8711 Engineering services
2677 Envelopes
0095 Environmental Quality & Housing
7359 Equipment rental
1794 Excavation work
9111 Executive offices
0091 Executive, Legislative & General
2892 Explosives
3851 Eyeglasses & eye safety shields
0034 Fabricated Metal Products
3498 Fabricated pipe & fittings
3069 Fabricated rubber products
3441 Fabricated structural metal
8744 Facilities support services
2599 Factory and bar furniture
7211 Family & commercial power laundry
5651 Family clothing stores
0761 Farm labor contractors
3523 Farm machinery
5083 Farm machinery
0762 Farm management services
4221 Farm product warehouses & storage
5191 Farm supplies
3999 Feathers, furs, umbrellas, models, etc.
6011 Federal reserve banks
6061 Federally chartered credit unions
6035 Federally chartered savings & loans
6111 Federally sponsored credit agencies
5632 Female accessory store
2251 Female stockings
4482 Ferries
1061 Ferroalloy ores, except vanadium
0139 Field crops farming
3569 Filters, firefighting equipment & lubricants
9311 Finance, tax & monetary policy
0093 Finance, Taxation & Monetary
2261 Finish cotton fabrics
2262 Finish synthetic fabrics
2269 Finishing plants
9224 Fire protection
6331 Fire, marine & casualty insurance
5146 Fish & seafood
0921 Fish hatchery & fish preserves
0912 Fishing
0009 Fishing, Hunting, and Trapping
3211 Flat glass
2087 Flavoring extracts/syrups
5713 Floor covering stores
1752 Floor work
5992 Florists
2041 Flour & grain mill products
5193 Flowers/florists. supplies
3824 Fluid meters
2026 Fluid milk
3593 Fluid power cylinders & actuators
3594 Fluid power pumps & motors
3492 Fluid power valves
2657 Folding cardboard boxes
0020 Food and Kindred Products
0182 Food crops grown under cover
2099 Food preparations
3556 Food products machinery
0054 Food Stores
5139 Footwear
6081 Foreign bank branches & agencies
4412 Foreign freight sea transport
8888 Foreign Governments
6082 Foreign trade & international banks
0831 Forest nurseries & forest products
0008 Forestry
0851 Forestry services
2092 Fresh/frozen fish/seafoods
2053 Frozen bakery prods exc bread
5142 Frozen foods
2037 Frozen fruits/juices/veggies
2038 Frozen specialties
5431 Fruit & vegetable markets
2035 Fruit/veggies seasoning/sauces
0179 Fruits & treenuts, orchards
5983 Fuel oil dealers
7261 Funeral homes & crematories
0271 Fur-bearing animals
5021 Furniture
0025 Furniture and Fixtures
0057 Furniture and Homefurnishings
5712 Furniture stores
2371 Furs
3644 Fuse boxes & non-current carrying conduits
3613 Fuses, circuit breakers & panel boards
3944 Games & toys
7212 Garment pressing
4932 Gas, combined with other services
3053 Gaskets & packing materials
5541 Gasoline service stations
3566 Gear speed changers
7538 General auto repair
0015 General Building Contractors
9611 General economic programs, administration
0191 General farms
9199 General government administration
5141 General grocery goods
1521 General house contractors
8062 General medical & surgical hospitals
0053 General Merchandise Stores
5399 General merchandise stores
4225 General warehousing & storage
5947 Gift & novelty stores
1793 Glass & glazing work
3221 Glass containers
3151 Gloves & mittens
2381 Gloves, except knit or leather gloves
1041 Gold ores
9631 Government administration of utilities
5153 Grain & beans
0172 Grape vineyards
3321 Gray iron foundries
4432 Great lakes freight transport
2771 Greeting cards
5411 Grocery stores
3295 Ground & treated minerals
3761 Guided missiles & space vehicles
2861 Gum & wood chemicals
3489 Guns & mortars
3275 Gypsum
3423 Hand & edged tools
3425 Hand saws & saw blades
3996 Hard surface floor covering
3429 Hardware
5072 Hardware
5251 Hardware stores
2426 Hardwood furniture, blocks & flooring
2435 Hardwood veneer & plywood
2353 Hats & caps
5499 Health foods, beverage stores, etc.
8049 Health practitioner's offices
0080 Health Services
5075 Heating and A/C equipment/supplies
3433 Heating equipment
7353 Heavy construction equipment rental
0016 Heavy Construction, exc Build
1629 Heavy construction, including dams and stadiums
7363 Help supply services
5945 Hobby & toy stores
0213 Hogs
3536 Hoists, cranes & monorails
0067 Holding & Investment Offices
5719 Home furnishing stores
5023 Home furnishings
8082 Home health care services
0272 Horses
6324 Hospital & medical service plans
7011 Hotels & motels
0070 Hotels & Other Lodging Places
1522 Hotels and motel building contractors
3142 House slippers
5722 Household appliance stores
3631 Household cooking equipment
3633 Household laundry equipment
3632 Household refrigerators & freezers
3635 Household vacuum cleaners
9531 Housing programs administration
0971 Hunting trapping & propagation
3241 Hydraulic cement
2024 Ice cream & frozen desserts
8322 Individual & family social services
1541 Industrial buildings & warehouses
3567 Industrial furnaces & ovens
2813 Industrial gases
2819 Industrial inorganic chemicals
7218 Industrial launderers
5084 Industrial machinery
0035 Industrial Machinery & Equipment
2869 Industrial organic chemicals
3543 Industrial patterns
1446 Industrial sand
5085 Industrial supplies
3537 Industrial trucks & tractors
3491 Industrial valves
7375 Information retrieval services
2816 Inorganic pigments
1796 Installation of building equipment
0038 Instruments & Related Products
6411 Insurance agents
0064 Insurance Agents/Brokers Services
0063 Insurance Carriers
6399 Insurance carriers
4131 Intercity & rural bus transport
8052 Intermediate care facility
9721 Internal affairs
3519 Internal combustion engines
6282 Investment advice
2835 In-vitro and in-vivo diagnostics
0134 Irish potato farming
3462 Iron & steel forgings
1011 Iron ores
4971 Irrigation Systems
3915 Jewelers materials
3911 Jewelry & precious metal
5094 Jewelry & watches
5944 Jewelry stores
8331 Job training & vocational rehab
8222 Junior colleges & technical institutes
0092 Justice, Public Order, Safety
1455 Kaolin & ball clay
8092 Kidney dialysis centers
3639 Kitchen appliances & sewing machines
2253 Knit outerwear mills
2254 Knit underwear mills
2259 Knitting mills
3826 Lab analysis instruments
3821 Lab apparatus & furniture
8631 Labor unions
2258 Lace and net knitting mills
2241 Lace, yarn & elastic weaving mills
3083 Laminated plastic shapes
9512 Land & wildlife conservation
6552 Land subdividers & developers
0781 Landscape planning and consulting
0782 Lawn & garden services
5261 Lawn & garden stores
3524 Lawn & garden tractors
2519 Lawn, wicker, fiberglass & plastic furniture
1031 Lead & zinc ores
3952 Lead pencils & art materials
2386 Leather and fleece lined clothing
0031 Leather and Leather Products
3111 Leather tanning
9222 Legal counsel
0081 Legal Services
8111 Legal services
9121 Legislative bodies
3579 Letter & paper handlers & word processors
8231 Libraries
6311 Life insurance
3274 Lime
7213 Linen supply
5921 Liquor stores
5154 Livestock
0291 Livestock & animal farms
0751 Livestock services, except veterinary
0741 Livestock veterinary services
0219 Livestock, except dairy and poultry
6163 Loan brokers
0041 Local & Interurban Transit
4111 Local & suburban transit
4141 Local bus charter service
4119 Local passenger transport
4214 Local trucking with storage
4212 Local trucking, without storage
3499 Locks, ladders, novelties, etc.
2411 Logging
2782 Looseleaf binders, checkbooks & accounting books
2992 Lubricating oil & grease
3161 Luggage
5948 Luggage & leather stores
5211 Lumber & building materials
0024 Lumber and Wood Products
5031 Lumber, plywood, millwork
2098 Macaroni & noodles
3545 Machine tools accessories
3695 Magnetic & optical disks, drums & tape
3322 Malleable iron foundries
2082 Malt liquors
8742 Management consulting services
8741 Management services
2761 Manifold business forms
2823 Manmade cellulose fibers
2097 Manufactured ice
2079 Margarine & other edible fats
4493 Marinas
3953 Marking devices
1741 Masonry & stone setting
2515 Mattresses & box springs
3829 Measuring & control devices
3586 Measuring and dispensing pumps
5147 Meat & meat products
5421 Meat & seafood markets
2011 Meat packing plants
3061 Mechanical rubber goods
5047 Medical & dental equipment
7352 Medical equipment rental
8071 Medical laboratories
2833 Medicinal chemicals & botanicals
7041 Member hotels & lodging houses
0086 Membership Organizations
7997 Membership sports & recreation clubs
5611 Mens & boys clothing stores
5136 Mens clothing & furnishings
2321 Mens shirts
3143 Men's shoes, except athletic
2325 Mens slacks & trousers
2311 Mens suits & coats
2322 Mens underwear
2326 Mens work clothing
3412 Metal barrels & drums
3411 Metal cans
3469 Metal cooking utensils & boxes
3541 Metal cutting machine tools
3442 Metal doors, moldings & trim
3497 Metal foil & leaf
3542 Metal forming machine tools
3398 Metal heat treating
2514 Metal household furniture
0010 Metal Mining
1081 Metal mining services
2522 Metal office furniture
2542 Metal partitions & display cases
3399 Metal powders, pastes, fasteners, etc.
5051 Metal products
3549 Metalworking machinery
3296 Mineral wool
3532 Mining machinery
0039 Misc Manufacturing Industries
9651 Miscellaneous commercial sectors regulation
4899 Miscellaneous communication services
2741 Miscellaneous publishing
0076 Miscellaneous Repair Services
0059 Miscellaneous Retail
8999 Miscellaneous services
2875 Mixing fertilizers
5271 Mobile home dealers
2451 Mobile homes
6515 Mobile homes site operators
3172 Money holders, cases, etc.
6162 Mortgage bankers & loan officers
0078 Motion Pictures
3716 Motor homes
4231 Motor terminal maintenance facility
3711 Motor vehicle bodies
3714 Motor vehicle parts & accessories
5571 Motorcycle dealers
3751 Motorcycles, bicycles & parts
3621 Motors & generators
7822 Movie & videotape distribution
7812 Movie & videotape productions
7829 Movie booking agencies
7922 Movie producers
7819 Movie production services
7832 Movie theaters, except drive-ins
8412 Museums & art galleries
0084 Museums, Botanicals, Zoos
5736 Musical instrument stores
3931 Musical instruments
4923 Nat gas transmission & distribution
0097 Nat. Security & Intl. Affairs
6021 National commercial banks
9711 National security
4924 Natural gas distribution
1321 Natural gas liquids
4922 Natural gas transmission
3812 Navigation & guidance equipment
2323 Neckties
5511 New & used car dealers
5994 News dealers & newsstands
7383 News syndicates
2711 Newspaper publishing & printing
2873 Nitrogen fertilizers
6514 Non-apartment residence operators
0099 Nonclassifiable Establishments
9999 Nonclassifiable establishments
3297 Nonclay refractories
8733 Noncommercial research
6091 Nondeposit trust facilities
0061 Nondepository Institutions
6062 Non-federal credit unions
6036 Non-federal savings & loans
3364 Nonferrous die-castings
3463 Nonferrous forgings
3369 Nonferrous foundries, except copper and aluminum
3356 Nonferrous metals rolling & drawing
3339 Nonferrous metals smelting & refining
3357 Nonferrous wire drawing & insulating
1481 Non-metal minerals services, except fuels
3299 Nonmetalic mineral products
0014 Nonmetallic Minerals, exc Fuel
6512 Nonresidential building operators
4522 Non-scheduled air transportation
2297 Nonwoven fabrics
8059 Nursing & care facilities
5044 Office equipment
1382 Oil & gas exploration services
1389 Oil & gas field services
0013 Oil and Gas Extraction
3533 Oil field machinery
6792 Oil royalty company
2843 Oils, greases & finishing agents
6722 Open-ended management & investment offices
1531 Operative builders
5048 Ophthalmic supplies
5995 Optical goods stores
3827 Optical instruments & lenses
8042 Optometrist's offices
3446 Ornamental metalwork
0181 Ornamental nurseries
0783 Ornamental shrubs and tree services
3842 Orthopedic & prosthetic appliances
8031 Osteopathic offices
7319 Other advertising
7999 Other amusement & recreation services
7539 Other auto repair shops
5599 Other automotive dealers
1542 Other building construction
6159 Other business credit institutions
7389 Other business services
6029 Other commercial banks
5099 Other durable goods
3149 Other footwear, except rubber shoes
5989 Other fuel dealers
3231 Other glass products
5149 Other groceries
8099 Other health services
7219 Other laundry & garment services
0919 Other marine products
8699 Other membership organizations
2329 Other mens clothing
1099 Other metal ores
5199 Other nondurable goods
1499 Other Nonmetallic minerals, except fuels
7299 Other personal services
4619 Other pipelines
7699 Other repair services
5999 Other retail stores
8299 Other schools & education services
8399 Other social services
3325 Other steel foundries
2299 Other textiles, including felt, jute & mohair
6733 Other trusts
7312 Outdoor advertising services
3643 Outlets, sockets & switches
3565 Packaging machinery
4783 Packing & crating
5231 Paint, glass & wallpaper stores
1721 Painting & paper hanging
2851 Paints & varnishes
5198 Paints, varnishes & supplies
0026 Paper and Allied Products
2655 Paper cans, tubes & drums
2656 Paper food containers, plates & cups
3554 Paper industries machinery
2621 Paper mills except cardboard
2676 Paper towels, diapers and sanitary napkins
2493 Particleboard & fiberboard
7515 Passenger car leasing
7514 Passenger car rental
4729 Passenger ticket offices
6794 Patent owners & lessors
3951 Pens & mechanical pencils
6371 Pensions, health & welfare funds
2721 Periodicals publishing & printing
6141 Personal credit institutions
0072 Personal Services
2879 Pesticides & agricultural chemicals
0029 Petroleum and Coal Products
5171 Petroleum bulk terminals
4925 Petroleum gas products
5172 Petroleum products
2911 Petroleum refining
2834 Pharmaceutical preparations
2874 Phosphate fertilizers
1475 Phosphate rock
5043 Photo equipment & supplies
7334 Photocopy services
7384 Photofinishing labs
3861 Photographic equipment
7221 Photographic studios
7991 Physical fitness facilities
5131 Piece goods & other dry goods
2392 Pillows, blankets, towels & slip covers
0046 Pipelines, except Natural Gas
1742 Plaster & insulation work
2673 Plastic bags
3085 Plastic bottles
3089 Plastic containers, utensils, boats, etc.
3081 Plastic film & sheets
3086 Plastic foam
3084 Plastic pipe
3088 Plastic plumbing fixtures
3082 Plastic profile shapes
5162 Plastics & resins
2821 Plastics materials
3087 Plastics, resins, custom compnd.g
2796 Platemaking
5074 Plumbing & water heating
3432 Plumbing fixture parts
1711 Plumbing, heating & air conditioning
8043 Podiatrist's offices
9221 Police protection
2842 Polishes, disinfectants & laundry cleaners
8651 Political organizations
3264 Porcelain electrical supplies
1474 Potash, soda & borate minerals
2096 Potato/corn chips & snacks
3269 Pottery products
0259 Poultry & eggs
0254 Poultry hatcheries
3546 Power driven hand tools
2452 Prefab wood buildings
3449 Prefabricated bar joists & metal plaster bases
3443 Prefabricated boilers & plates
3448 Prefabricated metal buildings
7372 Prepackaged software
2048 Prepared animal feeds
2045 Prepared flour mixes/doughs
3229 Pressed & blown glassware
3692 Primary batteries
0033 Primary Metal Industries
3672 Printed circuit boards
5111 Printing & writing paper
0027 Printing and Publishing
2893 Printing ink
3555 Printing trades machinery
7361 Private employment agencies
0088 Private Households
8811 Private households
7941 Pro sports clubs & promoters
2023 Processed dairy products
5049 Professional & engineering equipment
8621 Professional organizations
8063 Psychiatric hospitals
2531 Public building furniture
7992 Public golf courses
9431 Public health programs administration
9229 Public order & safety statistics
8743 Public relations services
2611 Pulp mills
3561 Pumps
7948 Race tracks & stables
3663 Radio & TV broadcasting equipment
7622 Radio & TV repair shops
4832 Radio stations
7313 Radio, TV & publisher's ad rep
3651 Radios, televisions & stereos
4812 Radiotelephone services
3743 Railroad equipment
6517 Railroad property lessors
4013 Railroad switches & terminals
0040 Railroad Transportation
4011 Railroads
0251 Raising cooking chickens
5159 Raw material farm-products
3273 Ready-mixed concrete
0065 Real Estate
6531 Real estate agents & managers
6798 Real estate investment trusts
6519 Real property lessors
5735 Record, tape & CD stores
3652 Records, CDs and tapes
4613 Refined petroleum pipelines
4222 Refrigerated warehousing & storage
7623 Refrigeration & air conditioning repair
5078 Refrigeration equipment
3585 Refrigeration, air conditioning & heating equipment
4953 Refuse systems
3625 Relays & industrial controls
6732 Religious & charitable trusts
8661 Religious organizations
4741 Rental of railroad cars
8361 Residential care
3645 Residential lighting
3676 Resistors
5461 Retail bakeries
7641 Reupholstery & furniture repair
0112 Rice farming
2044 Rice milling
4491 River, lake & canal transport of passengers
1611 Road construction, except elevated highways
4959 Road sweeping, toxic spill cleanup, etc.
2095 Roasted coffee
2384 Robes & dressing gowns
3547 Rolling mill machinery
5033 Roofing, siding & insulation materials
1761 Roofing, siding & sheet metal work
7021 Rooming & boarding houses
0030 Rubber & Misc Plastics
3021 Rubber & plastic footwear
3052 Rubber & plastic hoses & belts
5561 RV dealers
7033 RV parks & campsites
3199 Saddles, leather jackets & straps
2068 Salt/roast nuts/seeds
2013 Sausages/prepared products
2421 Sawmills & planing
3596 Scales & balances, except laboratory
4512 Scheduled air transportation
2397 Schiffli machine embroideries
4151 School buses
5093 Scrap & waste materials
3451 Screw machine products
4481 Sea transport of passengers
3341 Secondary nonferrous metals
7338 Secretarial & court reporting services
6289 Security & commodity exchange services
6231 Security & commodity exchanges
0062 Security and Commodity Brokers
6211 Security brokers & flotation companies
7382 Security systems services
3674 Semiconductors
5087 Service business equipment
0089 Services, NEC
2652 Setup paperboard boxes
4952 Sewage Systems
5949 Sewing & needlework stores
0214 Sheep & goats
3444 Sheet metalwork
0913 Shellfish
3731 Ship building & repairing
5113 Shipping paper & paper boxes
7251 Shoe repair & shine shops
5661 Shoe stores
6153 Short-term business credit
3993 Signs & advertising displays
2221 Silk & synthetics weaving mills
1044 Silver ores
3914 Silver, plated & stainless ware
8051 Skilled nursing care facility
2015 Slaughter/process poultry
3484 Small arms
3482 Small arms ammunition;
2841 Soaps & detergents
9441 Social & human resources administration
0083 Social Services
2252 Socks and leg warmers
2086 Soft drinks/water (can/bottle)
2436 Softwood veneer & plywood
0711 Soil preparation services
0116 Soybean farming
2075 Soybean oil mills
3764 Space propulsion parts
9661 Space research & technology
3769 Space vehicle equipment
3544 Special dies & tools
3559 Special industries machinery
8093 Special outpatient facilities
0017 Special Trade Contractors
1799 Special trade contractors
4226 Special warehousing & storage
7032 Sporting & recreational camps
5941 Sporting goods & bicycle stores
5091 Sporting goods & supplies
3648 Stage & outdoor lighting equipment
6022 State banks
2678 Stationery
5112 Stationery & office supply
5943 Stationery stores
4961 Steam & air conditioning supply
3324 Steel investment foundries
3317 Steel pipe & tubes
3493 Steel springs, except wire
3315 Steel wire, nails & spikes
0032 Stone, Clay, & Glass Products
3691 Storage batteries
3259 Structural clay products
1791 Structural steel erection
2439 Structural wood
0133 Sugarcane & sugar beet farming
6351 Surety insurance
3841 Surgical & medical instruments
8713 Surveying services
2824 Synthetic organic fibers
2822 Synthetic rubber
3795 Tanks & tank parts
7291 Tax return preparers
4121 Taxicabs
4822 Telegraphs
4813 Telephone services
3661 Telephones & phone switches
8734 Testing labs
3552 Textile machinery
0022 Textile Mill Products
2284 Thread mills
1743 Tile, marble & mosaic work
0811 Timber tracts
2296 Tire cord & fabrics
7534 Tire retreading & repair
3011 Tires & inner tubes
3011 Tires & inner tubes
5014 Tires & tubes
6541 Title abstract companies
6361 Title insurance
5194 Tobacco
0132 Tobacco farming
0021 Tobacco Products
2141 Tobacco stemming/redrying
5993 Tobacco stores & stands
4785 Toll collecting & inspection services
7532 Top, body repair & paint shops
4725 Tour operators
4492 Towing & tugboat services
5092 Toys & hobby goods
3612 Transformers
3677 Transformers & electronic coils
4731 Transportation agents & freight forwarding
0045 Transportation by Air
0037 Transportation Equipment
5088 Transportation equipment & supplies
3799 Transportation equipment, RVs, wheelbarrows, etc.
9621 Transportation programs administration
0047 Transportation Services
4724 Travel agencies
3792 Travel trailers & campers
0173 Tree nut groves
3713 Truck & bus bodies
7513 Truck rental, without driver
3715 Truck trailers
0042 Trucking & Warehousing
4213 Trucking, except local
3511 Turbines & generators
0253 Turkeys & turkey eggs
4833 TV stations
2791 Typesetting
0043 U.S. Postal Service
2674 Uncoated paper/Multiwall bags
2389 Uniforms, costumes & accessories
5699 Uniforms, wigs, costumes & sports clothing
6726 Unit investment trusts
4311 United States Postal Service
2512 Upholstered household furniture
1094 Uranium, radium and vanadium ore
9532 Urban planning & rural development
5015 Used automotive parts
5521 Used car dealers
5932 Used merchandise stores
7519 Utility trailer rental
3494 Valves & pipe fittings
5331 Variety stores
2076 Veg oil mills exc corn/soy
0161 Vegetable & melon farming
4173 Vehicle passenger terminals
5962 Vending machine operators
3581 Vending machines
9451 Veteran's affairs, except health
7841 Videotape rental
8249 Vocational schools
2679 Wallpaper, gift wrap, adding machine paper, etc.
7631 Watch, clock & jewelry repair
3873 Watches & clocks
4489 Water passenger transport
4941 Water supply
0044 Water Transportation
1781 Water well drilling
1623 Water, sewer & utility construction
2385 Waterproof outerwear
3548 Welding & soldering equipment
7692 Welding repair
2046 Wet corn milling
0111 Wheat farming
3263 Whiteware table & kitchen ware
0050 Wholesale Trade - Durable Goods
0051 Wholesale Trade - Nondurable Goods
2591 Window shade and drape hardware
5182 Wine & distilled spirits
2084 Wine and brandy
3496 Wire cloth, chain & fasteners
3495 Wire springs
5137 Womens & kids clothing
2331 Womens blouses & shirts
5621 Womens clothing stores
2335 Womens dresses
3171 Women's handbags
2339 Womens outerwear
3144 Women's shoes, except athletic
2337 Womens suit, skirts & coats
2341 Womens underwear
2449 Wood containers, tubs & crates
2491 Wood preserving
2429 Wooden barrels, shavings & shingles
2441 Wooden boxes & cases
2499 Wooden clothespins, ladders, frames, rulers, etc.
2541 Wooden display cases & cabinets
2431 Wooden doors, windows & moldings
2511 Wooden household furniture
2434 Wooden kitchen cabinets
2521 Wooden office furniture
2448 Wooden pallets & skids
2517 Wooden TV, stereo & sewing cabinets
3553 Woodworking machinery
2231 Wool weaving mills
1795 Wrecking & demolition work
3844 X-ray apparatus
2281 Yarn spinning mills
2282 Yarn throwing & winding mills
8422 Zoos & botanical gardens
Fiscal Period ending Month
January
February
March
April
May
June
July
August
September
October
November
December
Primary Address
No.
Street
Apt/Suit No.
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Bus Phone
Country
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Bermuda
Brunei Darussalam
Bolivia
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Democratic Republic/Congo
Central African Republic
Congo
Switzerland
Cote D'Ivoire (Ivory Coast)
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Serbia and Montenegro
Cuba
Cape Verde
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Federated States of Micronesia
Faroe Islands
France
France, Metropolitan
Gabon
Great Britain (UK)
Grenada
Georgia
French Guiana
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
S. Georgia and S. Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong
Heard Island and McDonald Islands
Honduras
Croatia (Hrvatska)
Haiti
Hungary
Indonesia
Ireland
Israel
India
British Indian Ocean Territory
Iraq
Iran
Iceland
Italy
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts and Nevis
Korea (North)
Korea (South)
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Madagascar
Marshall Islands
Macedonia
Mali
Myanmar
Mongolia
Macao
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand (Aotearoa)
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestinian Territory
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard and Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
Sao Tome and Principe
USSR (former)
El Salvador
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
East Timor
Turkey
Trinidad and Tobago
Tuvalu
Taiwan
Tanzania
Ukraine
Uganda
United Kingdom
United States Minor Outlying Islands
United States
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna
Samoa
Yemen
Mayotte
Yugoslavia (former)
South Africa
Zambia
Zaire (former)
Zimbabwe
Province
Mailing Address
Same As Primary Address (uncheck the box if different)
Address of outside Accountant should not be used
No.
Street
Apt/Suit No.
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Country
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Bermuda
Brunei Darussalam
Bolivia
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Democratic Republic/Congo
Central African Republic
Congo
Switzerland
Cote D'Ivoire (Ivory Coast)
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Serbia and Montenegro
Cuba
Cape Verde
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Federated States of Micronesia
Faroe Islands
France
France, Metropolitan
Gabon
Great Britain (UK)
Grenada
Georgia
French Guiana
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
S. Georgia and S. Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong
Heard Island and McDonald Islands
Honduras
Croatia (Hrvatska)
Haiti
Hungary
Indonesia
Ireland
Israel
India
British Indian Ocean Territory
Iraq
Iran
Iceland
Italy
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts and Nevis
Korea (North)
Korea (South)
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Madagascar
Marshall Islands
Macedonia
Mali
Myanmar
Mongolia
Macao
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand (Aotearoa)
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestinian Territory
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard and Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
Sao Tome and Principe
USSR (former)
El Salvador
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
East Timor
Turkey
Trinidad and Tobago
Tuvalu
Taiwan
Tanzania
Ukraine
Uganda
United Kingdom
United States Minor Outlying Islands
United States
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna
Samoa
Yemen
Mayotte
Yugoslavia (former)
South Africa
Zambia
Zaire (former)
Zimbabwe
Province
Withholding Information
No Withholding
First Payroll Date
in CCA Community
Withholding Employment tax
What CCA Cities?
hold
ctrl
to select multiple
NONE
BURTON
CLAYTON
CLEVELAND
DALTON
ELIDA
GENEVA-ON-THE-LAKE
GERMANTOWN
GRAND RAPIDS
GRAND RIVER
HIGHLAND HILLS
LINNDALE
MARBLE CLIFF
MENTOR-ON-THE-LAKE
MONTPELIER
MUNROE FALLS
NEW CARLISLE
NEW MADISON
NEW MIAMI
NEW PARIS
NORTH BALTIMORE
NORTH RANDALL
VILLAGE OF OAKWOOD
OBETZ
ORWELL
PAULDING
PHILLIPSBURG
PITSBURG
RIVERSIDE
ROCK CREEK
RUSHSYLVANIA
RUSSELLS POINT
SEVILLE
SHREVE
SOMERSET
SOUTH RUSSELL
WEST MILTON
Withholding Residence tax
What Residence Cities?
hold
ctrl
to select multiple
NONE
BURTON
CLAYTON
CLEVELAND
DALTON
ELIDA
GENEVA-ON-THE-LAKE
GERMANTOWN
GRAND RAPIDS
GRAND RIVER
HIGHLAND HILLS
LINNDALE
MARBLE CLIFF
MENTOR-ON-THE-LAKE
MONTPELIER
MUNROE FALLS
NEW CARLISLE
NEW MADISON
NEW MIAMI
NEW PARIS
NORTH BALTIMORE
NORTH RANDALL
VILLAGE OF OAKWOOD
OBETZ
ORWELL
PAULDING
PHILLIPSBURG
PITSBURG
RIVERSIDE
ROCK CREEK
RUSHSYLVANIA
RUSSELLS POINT
SEVILLE
SHREVE
SOMERSET
SOUTH RUSSELL
WEST MILTON
Do you Withhold more
than $200?
*
YES - Remit Monthly
NO - Remit Quarterly
Withholding Address
No.
Street
Apt/Suit No.
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip
Country
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Bermuda
Brunei Darussalam
Bolivia
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Democratic Republic/Congo
Central African Republic
Congo
Switzerland
Cote D'Ivoire (Ivory Coast)
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Serbia and Montenegro
Cuba
Cape Verde
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Federated States of Micronesia
Faroe Islands
France
France, Metropolitan
Gabon
Great Britain (UK)
Grenada
Georgia
French Guiana
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
S. Georgia and S. Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong
Heard Island and McDonald Islands
Honduras
Croatia (Hrvatska)
Haiti
Hungary
Indonesia
Ireland
Israel
India
British Indian Ocean Territory
Iraq
Iran
Iceland
Italy
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts and Nevis
Korea (North)
Korea (South)
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Madagascar
Marshall Islands
Macedonia
Mali
Myanmar
Mongolia
Macao
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand (Aotearoa)
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestinian Territory
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard and Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
Sao Tome and Principe
USSR (former)
El Salvador
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
East Timor
Turkey
Trinidad and Tobago
Tuvalu
Taiwan
Tanzania
Ukraine
Uganda
United Kingdom
United States Minor Outlying Islands
United States
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna
Samoa
Yemen
Mayotte
Yugoslavia (former)
South Africa
Zambia
Zaire (former)
Zimbabwe
Province
Name of the person responsible for filing withholding forms:
Title
Ph
email address
Authorization
*
Human Verification code
Enter the code
EXACTLY
from image displayed (No spaces)
By checking here, I agree that the information on this form is accurate to register as a taxpayer for CCA.
PRINT
©1998-2023, City of Cleveland - Division of Taxation. All rights reserved.
If you have any comments or questions about the Central Collection Agency's website you can