Employer'S Quarterly Return Of Income Tax Withheld Form

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Village of Westfield Center
EMPLOYER’S QUARTERLY RETURN OF INCOME TAX WITHHELD
Income Tax Department
Due on of Before
P.O. Box 750
For Period
Westfield Center, Ohio 44251
Tax Year
Notify Income Tax Department promptly of any change in ownership or name and
1.
Total Compensation Paid This Period
$_____________
address shown below.
2.
Total Withheld This Period
$_____________
3.
Adjustments to prior returns
$_____________
Account Number #
4.
Penalty and/or Interest
$_____________
Fed. ID #
5.
Total
$_____________
Make check or money order payable to:
Village of Westfield Center
I hereby certify that the information and statements contained herein are true and correct.
(signed)____________________________________________________
(Official Title) ______________________________________________
Date
Village of Westfield Center
EMPLOYER’S QUARTERLY RETURN OF INCOME TAX WITHHELD
Income Tax Department
Due on of Before
P.O. Box 750
For Period
Westfield Center, Ohio 44251
Tax Year
Notify Income Tax Department promptly of any change in ownership or name and
1.
Total Compensation Paid This Period
$_____________
address shown below.
2.
Total Withheld This Period
$_____________
3.
Adjustments to prior returns
$_____________
Account Number #
4.
Penalty and/or Interest
$_____________
Fed. ID #
5.
Total
$_____________
Make check or money order payable to:
Village of Westfield Center
I hereby certify that the information and statements contained herein are true and correct.
(signed)____________________________________________________
(Official Title) ______________________________________________
Date
Village of Westfield Center
EMPLOYER’S QUARTERLY RETURN OF INCOME TAX WITHHELD
Income Tax Department
Due on of Before
P.O. Box 750
For Period
Westfield Center, Ohio 44251
Tax Year
1.
Total Compensation Paid This Period
Notify Income Tax Department promptly of any change in ownership or name and
$_____________
address shown below.
2.
Total Withheld This Period
$_____________
3.
Adjustments to prior returns
$_____________
Account Number #
4.
Penalty and/or Interest
$_____________
Fed. ID #
5.
Total
$_____________
Make check or money order payable to:
Village of Westfield Center
I hereby certify that the information and statements contained herein are true and correct.
(signed)____________________________________________________
(Official Title) ______________________________________________
Date

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