City Of Delaware Income Tax Employer'S Annual Reconciliation Of Tax Wittheld Form - 2016 Page 3

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2016 CURRENT RATE: 1.85%
QUARTERLY WITHHOLDING COUPONS
Line 1— Enter tax withheld on all qualifying wages paid to or
Line 4—Adjust current payment of actual tax withheld for under
accrued by all employees working within the City of Delaware.
payment or over payment in previous period. Attach explanation.
Line 2—Enter tax withheld as courtesy to Delaware City residents
Lines 5 & 6—See instructions under Failure To File Return and Pay
and indicate percentage used. If unsure of proper courtesy rate,
Tax.
please call the Income Tax Department.
Line 7—Enter total amount to be remitted.
Line 3—Enter total of Lines 1 and 2.
Period Ending DECEMBER 31, due on or before JANUARY 15
2016 DELAWARE TAX RATE: 1.85%
CITY OF DELAWARE INCOME TAX
This return must be filed on or before the due date shown.
EMPLOYER’S RETURN OF TAX WITHHELD
1. Tax withheld on income earned in Delaware
1.
I hereby certify that the information and statements
contained herein and in any schedules or exhibits
2. Courtesy tax withheld at __________________% (reduced credit rate)
2.
attached are true and correct.
3. Total tax withheld in period for Delaware.
3.
Print Name: ____________________________________
4. Adjustment of tax for prior period (explain on back)
4.
Signed: ________________________________________
5. Interest (.42% per month)
5.
Official Title: ____________________________________
6. Penalty (50% of tax due)
6.
Date: __________________________________________
7. TOTAL (including interest and penalty if due)
7.
Make check or money order payable to
Delaware Tax ID: ______________ -W
FIN: _____________________________
CITY OF DELAWARE INCOME TAX
Company Name and Address:
__________________________________________________
4TH
4TH
4TH
Mail to
__________________________________________________
City of Delaware Income Tax
__________________________________________________
QTR
QTR
QTR
PO Box 496
Delaware OH 43015
Company Email: _________________________________________ Phone Number: ___________________________
740-203-1225
Period Ending SEPTEMBER 30, due on or before OCTOBER 15
2016 DELAWARE TAX RATE: 1.85%
CITY OF DELAWARE INCOME TAX
This return must be filed on or before the due date shown.
EMPLOYER’S RETURN OF TAX WITHHELD
1. Tax withheld on income earned in Delaware
1.
I hereby certify that the information and statements
contained herein and in any schedules or exhibits
2. Courtesy tax withheld at __________________% (reduced credit rate)
2.
attached are true and correct.
3. Total tax withheld in period for Delaware.
3.
Print Name: ____________________________________
4. Adjustment of tax for prior period (explain on back)
4.
Signed: ________________________________________
5. Interest (.42% per month)
5.
Official Title: ____________________________________
6. Penalty (50% of tax due)
6.
Date: __________________________________________
7. TOTAL (including interest and penalty if due)
7.
Make check or money order payable to
Delaware Tax ID: ______________ -W
FIN: _____________________________
CITY OF DELAWARE INCOME TAX
Company Name and Address:
__________________________________________________
3RD
3RD
3RD
Mail to
__________________________________________________
City of Delaware Income Tax
__________________________________________________
QTR
QTR
QTR
PO Box 496
Delaware OH 43015
Company Email: _________________________________________ Phone Number: ___________________________
740-203-1225

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