Form Wcwt-5 Application For Refund Of Wilmington City Wage Tax 2006 Page 4
ADVERTISEMENT
1
2
3
4Page 4
~
SECTION 3 - EMPLOYER CERTIFICATION
~
(CERTIFICATION
REQUIRED FOR PROCESSING)
Questions
2.
Yes 0
No 0
No 0
1.
Did you File for 2005 Refund?
IfYes, Have You Since Changed Your Address?
Yes 0
Signature/Identification
TAXPAYER
SIGNATURE
DATE
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
DATE
SOCIAL SECURITY NUMBER
NAME
ADDRESS
TELEPHONE NUMBER
IDENTIFYING
NUMBER
ISECTION 4 - PROCESSING - TAX OFFICE USE ONLY
AlP CLAIM
NUMBER
AlP CLAIM
BATCH NUMBER
WAGE
BATCH NUMBER
EMPLOYERS
ACCOUNT
NUMBER
REFUND AMOUNT
[
APPROVED BY
-
DIVISION HEAD
DEPARTARTMENT HEAD
APPROVAL (OVER $10,000)
PROCESSED BY
CERTIFICATION
BY EMPLOYER:
I certify that the facts shown above supporting
Employee's
Claim for allocation and
non-taxable
income
are correct
based
on available
payroll
records.
-
FEI/FN
AUTHORIZED OFFICIAL (Type or Print)
TELEPHONE #
AUTHORIZED OFFICIAL (Signature)
TITLE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial