Reconciliation Of Employee'S Wage Tax Withheld - Village Tax Form

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VILLAGE TAX FORM
RECONCILIATION OF EMPLOYEE’S WAGE TAX WITHHELD
TOTAL WAGES PAID IN TAX YEAR _______
$ ____________________
ST
1
QUARTER TAXES PAID TO DESHLER $______________
ND
2
QUARTER TAXES PAID TO DESHLER $______________
RD
3
QUARTER TAXES PAID TO DESHLER $______________
TH
4
QUARTER TAXES PAID TO DESHLER $______________
TOTAL TAXES WITHHELD AND PAID
$_____________________
TOTAL NUMBER OF EMPLOYEES FROM WHOM
TAXES WERE WITHHELD ___________________
SUBMIT WITH LIST OF EMPLOYEES OR COPIES OF W-2’S
NAME OF EMPLOYER ___________________________
ADDRESS ______________________________________
______________________________________
FED. ID. #_______________________________________
SIGNED ________________________________
DATE __________________________________

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