Instructions For Preparing And Filing Form W-3q Reconciliation - Springfield, Ohio
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2INSTRUCTIONS FOR PREPARING AND FILING FORM W-3Q RECONCILIATION
This reconciliation form must be filed on or before January 31, with The Springfield Income Tax Division, Springfield, Ohio. The return must be
accompanied by copies of wage statements (or tabulation) listing including:
1.
Name and address of employee
2.
Social Security Number
3.
Gross Earnings
4.
Amount of Tax Withheld for Springfield
5.
Account Number - Name and Address of Withholding Agent (employer)
When individual wage statements are submitted, please include a machine tape of tax withheld, together with all adjustments necessary to reconcile
total payroll reported and payroll as listed in corporate and or individual liability return.
(ENTER YEAR)
For CALENDAR YEAR
RECONCILIATION OF QUARTERLY RETURNS
OF TAX WITHHELD FOR SPRINGFIELD
TAX WITHHELD AND PAID FROM WAGES DURING YEAR
CITY OF SPRINGFIELD, OHIO
Form W-3Q
WITH STATEMENTS OF WAGES SUBJECT TO TAX
REPORTED BY QUARTERLY (W-1Q) RETURNS OF TAX WITHHELD.
1. NUMBER OF EMPLOYEES REPRESENTED BY W-2 STATEMENTS
ATTACHED……………………………………………………………………
_____________
QUARTER ENDED MARCH 31
$ __________________
2. TOTAL PAYROLL TAXABLE TO SPRINGFIELD …………….………….
$ ____________
QUARTER ENDED JUNE 30
$ __________________
3. TAX AT RATE OF 2% ………………………………….……………………
$ ____________
QUARTER ENDED SEPTEMBER 30
$ __________________
QUARTER ENDED DECEMBER 31
$ __________________
Print or Type YOUR NAME AND ADDRESS HERE including ACCOUNT NUMBER.
4. TOTAL PAID DURING YEAR
$ __________________
IF LINE 4 IS NOT EQUAL TO LINE 3, ATTACH
EXPLANATION OR REMIT AMOUNT DUE AND
ENTER ON LINE 5.
Enter Your F.E.I.N. or S.S.N. Here
5. ADJUSTMENT AMOUNT DUE
& PAID WITH THIS
$ __________________
DUE ON OR BEFORE JANUARY 31
RECONCILIATION
SEE INSTRUCTIONS ON THIS PAGE FOR COMPLETING FORM
MAIL TO: City of Springfield
Income Tax Division
City Hall
P.O. Box 5200
RETURN THIS COPY
Springfield, Ohio 45501-5200
Please read the instructions carefully and complete each form in its entirety.
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