Fw-3 - Annual Reconciliation Form

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2006 City of Fairborn
Annual Reconciliation (FW-3)
Business Name: ______________________________________________________
January
July
Address: ____________________________________________________________
February
August
City: ___________________________________ State: _______ Zip: _________
FID/EIN: ____________________________________________________________
March
September
1
Quarter
3
Quarter
st
rd
SUBMIT BY FEBRUARY 28
W-2’S MUST BE ATTACHED
April
October
I hereby certify the information & statements contained herein are true and correct.
May
November
Signed: ____________________________________________________________
June
December
(Business Name)
2
Quarter
4
Quarter
nd
th
By: ________________________________________________________________
(Responsible Officer)
Number of Employees:
Total Gross Compensation:
Mail to: City of Fairborn, Division of Taxation
Tax Due at 1.5%:
44 West Hebble Avenue, Fairborn, OH 45324-4999
Tax Paid:
Balance Due or (Overpayment):

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