Form W-3 - Wage Reconciliation Form - 2001
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1WAGE RECONCILIATION FORM W-3
TH
DUE ON OR BEFORE FEBRUARY 15
OF EACH YEAR FOR EACH EMPLOYER.
Mail to: Cincinnati Income Tax Bureau P.O. Box 5486 Cincinnati, OH 45201-5486
Office phone: (513) 352-3838
THIS SPACE IS FOR OFFICIAL USE ONLY
NAME
ACCT NO.
FID NO.
ADDRESS
COMPLETE THE BLOCKS TO THE RIGHT ONLY IF THIS SPACE IS BLANK OR
CITY
STATE
THE PREPRINTED INFORMATION IS INCORRECT.
YEAR 2001
ZIP CODE
FEDERAL ID#
MONTH/QUARTER
TOTAL PAYROLL
TAXABLE PAYROLL
TAX RATE
CINCINNATI TAX
1. JANUARY
2.1%
X
2. FEBRUARY
2.1%
X
3. MARCH
2.1%
X
ST
OR 1
QUARTER
4. APRIL
2.1%
X
5. MAY
2.1%
X
6. JUNE
2.1%
X
ND
OR 2
QUARTER
7. JULY
2.1%
X
8. AUGUST
2.1%
X
9. SEPTEMBER
2.1%
X
RD
OR 3
QUARTER
10. OCTOBER
2.1%
X
11. NOVEMBER
2.1%
X
12. DECEMBER
2.1%
X
TH
OR 4
QUARTER
13.
TOTAL YEAR
14.
Tips and gratuities included in taxable payroll …….…
15.
Deduct credit for other city tax (not to exceed 2.1% (.021)) withheld for Cincinnati residents.………..….
16.
Amount of withholdings payable to Cincinnati for the year (Line 13 less Line 15)…..
17.
Actual withholdings remitted to Cincinnati for the year via withholding coupons……
18. TAX DUE (
)………………………………………………………….
Line 16 minus Line 17
19.
Enter amount to be refunded (Line 17 minus Line 16)
)………………..
(ATTACH FULL EXPLANATION
OR
20.
Enter amount to be credited to next year (Line 17 minus Line 16)
.……
(ATTACH FULL EXPLANATION)
Number of Employees Listed ___________ SIGNATURE _______________________________________ DATE _________________
SOCIAL SECURITY
TOTAL EARNINGS
CINCINNATI
OTHER CITY
NUMBER
NAME, ADDRESS AND ZIP CODE OF EMPLOYEE
FOR THE YEAR
TAX WITHHELD
TAX WITHHELD
Submit employee W-2 forms or complete the above section. Please attach additional listing if necessary.
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