Employer'S Withholding Reconciliation - City Of Canfield Income Tax

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CITY OF CANFIELD INCOME TAX ~ 104 LISBON STREET ~ CANFIELD OHIO 44406-1416
PHONE: 330-533-1101
FAX: 330-533-4415
TAX YEAR:______ EMPLOYER’S WITHHOLDING RECONCILIATON
DUE DATE: Feb. 28
ACCOUNT # __________
FEDERAL ID NUMBER ___________________________
NAME
PREPARER ______________________________________
ADDRESS
LOCAL PHONE # ____________________
INSTRUCTIONS:
1. Attach copies of all W-2 forms and 1099 Misc. Income Forms.
2. ENTER PAYROLL IN MANNER IN WHICH PAYMENTS WERE MADE (QUARTERLY OR MONTHLY).
3. Attach check payable to CITY OF CANFIELD INCOME TAX, for difference if withholding exceeds remittance.
4. If remittance exceeds amount withheld, give explanation and request refund below.
5. Attach explanation if Column 2 is used.
6. Number of employees: __________.
(1)
(2) Payroll Not
(3) Payroll
(4)
(5)Tax Paid Per
Period
Gross Payroll
Subject to Tax.
Subject to Tax
Tax Due
Your Records
January
February
March/
Quarter-1
April
May
June/
Quarter-2
July
August
September/
Quarter-3
October
November
December/
Quarter-4
TOTAL REMITTANCE MADE:
_______________
DIFFERENCE If any explain below):
_______________
Underpaid: Amount Owed ___________
Overpaid: Refund Amount ___________
Employer explain any difference: _____________________________________________________________
___________________________________________________________________________________________
WH Reconcilaiton/5

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