Year-End Withholding Tax Reconciliation Form - Ohio Department Of Income Tax

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Village of Loudonville
Department of Income Tax
156 N. Water Street
P.O. Box 115
Loudonville, OH 44842
Phone: 419-994-3282
Fax: 419-994-3213 Email:
Account Number: ______________
FEIN #: ______________________
Employer:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
YEAR-END WITHHOLDING TAX RECONCILIATION FORM
Tax Year:_________
Amount Paid
Amount Paid
Month of January
Month of July
Month of February
Month of August
Month of March
Month of September
st
rd
1
Quarter
3
Quarter
Month of April
Month of October
Month of May
Month of November
Month of June
Month of December
nd
th
2
Quarter
4
Quarter
1. Total Remitted for the Year
$
2. Total Number of Employees
3. Total Payroll Subject to Withholding
$
4. Withholding tax liability (1.75% of Line 3)
$
5. Courtesy Residency Tax Withheld
$
6. Total Liability Amount (Line 4 plus line 5)
$
7.
Overpayment (If Line 1 is greater than Line 6)
$
8.
1)
$
Additional Tax Due (if line 6 is greater than Line
Submit copy of W-2’s with this form.
_
Signature
Date
Phone Number
Contact Person
WH REC LV.DOC
WH-REC-LV

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