City of Fairfield - Income Tax Division
701 Wessel Drive
Fairfield OH 45014-3611
513.867.5327
Withholding Tax Reconciliation for Employer’s Monthly/Quarterly Returns for Tax Year 2006 – Form W-3
Due on or Before February 28, 2007
Acct/FID #:
Name:
Address:
City, State, Zip:
Employer’s Withholding Tax Worksheet – Keep for your records
Wages
Withholding
Wages
Withholding
January
$ _____________ $ _____________
July
$ _____________ $ _____________
February
$ _____________ $ _____________
August
$ _____________ $ _____________
March
$ _____________ $ _____________
September
$ _____________ $ _____________
*
*
*
*
Total 1
Qtr
$ _____________ $ _____________
0.00
Total 3rd Qtr
$ _____________ $ _____________
st
0.00
0.00
0.00
April
$ _____________ $ _____________
October
$ _____________ $ _____________
May
$ _____________ $ _____________
November
$ _____________ $ _____________
June
$ _____________ $ _____________
December
$ _____________ $ _____________
*
*
0.00
*
*
0.00
Total 2
Qtr
$ _____________ $ _____________
Total 4
Qtr
$ _____________ $ _____________
nd
th
0.00
0.00
*
Denotes an automatically calculated field.
Withholding Tax Reconciliation for Employer’s Monthly/Quarterly Returns for Tax Year 2006 – Form W-3
Acct/FID #:
Due Date: February 28, 2007
Remit to: Fairfield Income Tax Division, 701 Wessel Drive,
Name:
Fairfield OH 45014-3611
Address:
1.
Total Number of Employees
____________
City, State, Zip:
(
)
per W-2s which must be attached
2.
Total Payroll for the Year ……………………………………………………………………………………. $ _______________
3.
Less Payroll Not Subject to Tax (
) ………………………………………………… $ _______________
list/attach explanation
*
0.00
4.
Payroll subject to Tax ………………………………………………………………………………………… $ _______________
*
0.00
5.
Withholding Tax Liability @ 1.5% (.015) …………………………………………………………………… $ _______________
*
0.00
6.
Total Income Withheld from Wages ……………………………………………………………………… $ _______________
1
Qtr
$ ____________ 2
Qtr $ ____________ 3
Qtr $ ____________ 4
Qtr $ ____________
st
nd
rd
th
7.
Balance Due or Overpayment (Line 5 less Line 6) ……………………………………………………… $ _______________
An overpayment will be credited towards next payment unless a refund is requested.