Form Mw-1 - Employer'S Return Of Tax Withheld Page 2

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Account
CITY OF MIDDLETOWN, EMPLOYER'S RETURN FO TAX WITHHELD
RETURNS ARE DUE THE 15TH DAY AFTER QUARTER END
YEAR
PERIOD
AMOUNT ENCLOSED
3rd Qtr
$
Federal I.D.
Tax rate: 1.75%
Telephone
FOR THE QUARTER ENDING :
September 30
Authorized Signature
DUE ON OR BEFORE:
October 15
Print or Type Name
Is this a final return ?
YES
NO
If yes, explain on reverse
Official Title
Make check payable and mail to:
CITY OF MIDDLETOWN
PO Box 630157
Cincinnati OH 45263-0157
Form MW-1
RETURNS ARE DUE THE 15TH DAY AFTER QUARTER END
Account
CITY OF MIDDLETOWN, EMPLOYER'S RETURN FO TAX WITHHELD
YEAR
PERIOD
AMOUNT ENCLOSED
4th Qtr
$
Federal I.D.
Tax rate: 1.75%
Telephone
FOR THE QUARTER ENDING :
December 31
Authorized Signature
DUE ON OR BEFORE:
January 15
Print or Type Name
Is this a final return ?
YES
NO
If yes, explain on reverse
Official Title
Make check payable and mail to:
CITY OF MIDDLETOWN
PO Box 630157
Cincinnati OH 45263-0157
Form MW-1

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