City Of Delaware Income Tax Employer'S Annual Reconciliation Of Tax Wittheld Form - 2016 Page 2

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CITY OF DELAWARE ANNUAL RECONCILIATION INSTRUCTIONS
On or before the last day of February of each year, each employer must
The front of the Annual Reconciliation Form must show a breakdown of
file a withholding reconciliation using the City of Delaware form.
all withholding payments made either quarterly or monthly in the
Copies of all W-2 Forms applicable to the reconciliation must be
boxes provided. Sections 1, 2, 3, 4, and 5 must be completed.
attached.
The total tax paid should be equal to the current City of Delaware
All W-2’s must furnish the name, address, social security number,
income tax rate (or the reduced courtesy withholding rate) of Box 2.
qualifying wages, city tax withheld, name of city for which tax was
withheld, and any other compensation paid to the individual. If copies
The completed Annual Reconciliation Form and all attachments must
of the W-2 Forms are not available, each employer must provide a
be submitted to the City of Delaware Income Tax Department on or
before the last day of February each year. Failure to file the Annual
listing of all employees subject to Delaware tax. The listing shall
Reconciliation Form with attachments by the last day of February
require the same type of information as is required on the W-2 Form.
each year will result in a penalty assessment. Any questions
Any individual, association, or business entity that is required under the
regarding this form should be referred to the Income Tax
Internal Revenue Code to issue Form 1099 to any person shall, on or
Department at 740-203-1225.
before the last day of February of each year, file copies of said 1099’s
to the Income Tax Department. If 1099 copies are not available, a
Special Notice: The City of Delaware will now accept electronic
listing with the same information as contained on Form 1099 may be
filing of year-end W-2 and reconciliation information. Employer
submitted. Failure to comply may result in penalty assessment.
must use the SSA format that includes local tax information.
2016 CURRENT RATE: 1.85%
CITY OF DELAWARE ANNUAL RECONCILIATION FORM
CITY OF DELAWARE INCOME TAX EMPLOYER’S ANNUAL RECONCILIATION OF TAX WITHHELD
CITY OF DELAWARE INCOME TAX
Make check or money order payable to
Mail to
CITY OF DELAWARE INCOME TAX
PO BOX 496
DELAWARE OH 43015
740-203-1225
Payment Enclosed: _____
IncomeTax@DelawareOhio.Net
Email to
Close Account: _____
Refund Requested: _____
Due on or before the last day of February with W-2’s attached. All sections must be completed.
JAN
JULY
1. Total #
Delaware Tax ID: ________________ -W
FIN: ________________________________________
Delaware
#__________
W-2’s
FEB
AUG
Company Name and Address:
______________________________________________________________
2. Workplace
wages
______________________________________________________________
MAR
SEP
$__________
______________________________________________________________
3. Workplace
1ST QTR
3RD QTR
tax
$__________
withheld
I hereby certify that the information and statements contained herein
APR
OCT
4. Residence
tax
and in any schedules or exhibits attached are true and correct.
$__________
withheld
MAY
NOV
5. Total taxes
paid to
JUN
DEC
Printed Name: __________________________________ Signature: _______________________________________
$__________
Delaware
Official Title: _________________________________________ Date: _____________________________________
6. BALANCE
2ND QTR
4TH QTR
DUE OR
Email: ___________________________________________ Phone Number: ________________________________
$__________
REFUND

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