CITY OF SIDNEY
RECONCILIATION OF RETURNS
FOR TAX YEAR ENDING 200___
SUBMIT BY FEBRUARY 28. W-2S MUST BE ATTACHED
Phone: (937) 498-8111
1) Total number of W-2s attached:
JANUARY
APRIL
JULY
OCTOBER
$
2) Total payroll for year:
FEBRUARY
MAY
AUGUST
NOVEMBER
$
3) Less payroll not subject to tax:
MARCH
JUNE
SEPTEMBER
DECEMBER
$
4) Payroll subject to tax:
1ST QUARTER
2ND QUARTER
3RD QUARTER
4TH QUARTER
$
$
$
$
$
5)
Withholding tax liability @1.5% of line 4
6.
Total Paid For Year:
$_________________
ACCOUNT NO.
I hereby certify that the information and statements contained herein are true and correct.
COMPANY NAME
Signed
Title
ADDRESS
City of Sidney
ADDRESS
Mail to:
CITY, STATE ZIP
Department of Taxation & Revenue
201 W Poplar St
Sidney OH
45365
CITY FORM SW-3