Form 501 - Employer'S Depository Receipt Of Earned Income Tax Withheld
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1Form 501 Employer’s Depository Receipt of Earned Income Tax Withheld
Return to:
Capital Tax Collection Bureau
1. Actual Earned Income Tax
Withheld
2. Interest – Penalty . . . . . .
Clear Form Data
1% per month from due date
3. Adjustments
I hereby certify that the information contained herein
Add
(Subtract)
is true and correct.
4. Total paid with remittance
0.00
Authorized Signature
Title
Date
These funds will be transmitted via ACH
on ______________________(Date)
Employer Number
Year
PSD No.
Month
Due Date
Qtr.
BUREAU COPY
Employer’s Copy – Record payments here for your records
Amount Paid
Date Paid
Check Number
January
$
February
$
March
$
April
$
May
$
June
$
Employer’s Copy – Record payments here for your records
Amount Paid
Date Paid
Check Number
July
$
August
$
September
$
October
$
November
$
December
$
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Parent category: Financial