Employer'S Monthly/quarterly Withholding Remittance Form - City Of Findlay - Income Tax Department

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City of Findlay
Income Tax Department
Post Office Box 862
Findlay, Ohio 45839-0862
PH: 419-424-7133 FX: 419-424-7410
Employer’s Monthly/Quarterly Withholding Remittance
____________________________________
1. Findlay Tax Withheld
__________________.______
Name
____________________________________
2. Intra-year Adjustments
__________________.______
Address
____________________________________
3. Net Liability
__________________.______
City
ST
Zip
4. Penalty
__________________.______
Fed ID: _______-______________________
5. Interest
__________________.______
Year: __________ Month/Quarter:________
6. Payment Enclosed
__________________.______
I certify, to the best of my knowledge and belief, that the information shown on this document is true, correct, and complete.
__________________________________________
__________________________________________
Signature of Responsible Party
Phone
Title
Date
1967 – 2009: 1.0%
2010 – 2012: 1.25%
2013 – present: 1.0%

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