Form W-3 - Batavia Withholding Tax Reconciliation Form
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1Form W-3
Village of Batavia
Income Tax Bureau
Batavia Withholding Tax Reconciliation
Total Batavia income tax withheld during year for:
1. Total number of employees
_____________________
First quarter, ending March 31 .................. $ __________________
2. Total payroll for the year
$ ____________________
Second quarter, ending June 30 ................. $ __________________
Third quarter, ending September 30 .......... $ __________________
Fourth quarter, ending December 31 ......... $ __________________
3. Less payroll not subject to tax
$ ____________________
6.
Total remitted for the year ......................... $ __________________
7.
Overpayment $___________ or tax due: .. $ __________________
4. Payroll subject to tax
$ ____________________
5. Withholding tax liability @ 1.0%
$ ____________________
Do not write in space below
Employer’s name and address
_____________________________________________________
Name
___________________________________________________
Address
________________________________________________________
_______________________________________________
City, State, ZIP
Tax Year ___________________________
Instructions
If Item 7 above shows overpayment and you want a refund, attach request to this form. If additional tax is due, submit payment when filing.
Batavia’s tax ordinance requires employers subject to the tax to file this information annually. This report requires the name and address of each
employee subject to the tax at any time during the year, the total earnings of each such employee, the earnings subject to the tax (usually the same as
total earnings), and the amount of Batavia tax withheld. The form below is for employers to use if convenient; to make more space, use the back side
or attach more sheets. Any employer using a payroll accounting system may use that system to report. Mail or deliver reports to the Village of
Batavia Income Tax Bureau, 389 E. Main St., Batavia, Ohio 45103 by February 28 after the end of the year for which the tax applies.
Name and address of employee
Employee
Total earnings
Earnings
Batavia tax
tax ID (SSN)
for the year
subject to tax
withheld
Total this page
Total all pages
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