Withholding Tax Reconciliation Form

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WITHHOLDING TAX RECONCILIATION
ACCOUNT NO.
__
We withhold taxes as a courtesy. We have no employees working in the city.
Final Return, explain on reverse side.
1. Total number of W-2s attached
________________
Income Tax Withheld for Tax Year _____
2. Total payroll for the year
________________
First quarter ending
_________________
3. Less payroll not subject to tax
________________
Second quarter ending _________________
(Must include explanation on the reverse) ________________
Third quarter ending
_________________
4. Payroll subject to
tax ________________
Fourth quarter ending
_________________
5. Withholding liability at
x line 4 ________________
6. Total remitted for the year _____________
Must equal line 5. If not, explain on reverse.)
7. Overpayment credited to next year*
________________ OR 8. Additional tax due
_________________
*Refund not issued unless requested. Attach explanation.
No taxes or credits of less than $1.00 shall be
collected, credited, or refunded.
_________________________________________________________
Signature of Person Preparing Form and Title
Date
__________________________________________
Print Name & Telephone Number of Contact Person
MUST BE RETURNED WITH W-2's AND 1099’s
BY THE END OF FEBRUARY FOLLOWING THE
TAX YEAR.
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