20__
RECONCILIATION OF EMPLOYERS QUARTERLY RETURN OF TAX WITHHELD
Form W-3
VILLAGE OF McCOMB, OHIO—INCOME TAX DEPARTMENT
1. Total number of copies of employee’s
3. Total McComb income tax withheld on wages during the past year as
statements (Forms W-2) transmitted.
__________________
shown on line 1 of Quarterly Returns (Forms W-1).
2. Total McComb income tax withheld on
Quarter 1 ended March 31-----------------___________________
wages paid this year as shown on copies of
Quarter 2 ended June 30-------------------____________________
employee’s statements.
__________________
Quarter 3 ended Sept. 30-------------------____________________
Quarter 4 ended Dec. 31-------------------____________________
Total--------___________________
Tax ID#
Employer name & address
I hereby certify that the information contained herein
is true and correct.
(Signed) _________________________________
Date
____________________
----------------------------------------------------------------------------------Cut along this line-----------------------------------------------------------------------------------------
An original of this reconciliation form must be filed with the Village Income Tax Department on or before
January 31 of the following year unless you discontinued having employees before December 31, in which case
it must be filed within thirty days after the last payment of wages.
A copy of the Federal Form W-2 must accompany this form for each employee from whom tax has been
withheld during the past year. The Federal Forms must be sorted by tax ID or by the employee’s last name.
In lieu of a copy of the Federal Form W-2, a computer listing may be substituted. The listing must contain all
information that would appear on the Form W-2. The listing must be sorted by tax ID or by the emploee’s last
name.
Mailing Address
Village of McComb
Income Tax Department
P. O. Box 756
McComb, OH 45858