Form Os-3710 - Annual Reconciliation Of Taxes Withheld
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1DIVISION OF REVENUE AND TAXATION
COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS
ANNUAL RECONCILIATION OF TAXES WITHHELD
2003
CY
(Please type or print in ink)
A
C
D
Employer
Federal employer identification no.
CNMI employer identification
no.
B
E
F
Mailing address
Person to contact
Telephone no.
(
)
1 Totals per
1A CHAPTER 2
1B CHAPTER 7
1C
TOTAL
1D
Total
1E
Wages
Quarterly Returns
Tax Withheld
Tax Withheld
Tax Withheld
Tax Paid
and Salaries
'
a) 1st Quarter
'
b) 2nd Quarter
'
c) 3rd Quarter
'
d) 4th Quarter
'
e) Subtotal (a thru d)
'
2a Total per W-2CM
b
Differ
'
ence
'
3 No. of W-2CM attached to Form OS-3710
G
G
4 Are you filing magnetically?
YES
NO
FOR OFFICIAL USE ONLY
Date filed*
Date paid
Receipt No.
Charges $
No. of W-2CM filed
Verified by
Exceptions/Remarks
OS-3710
* If received after the due date, show postmark.
Form
(Rev. 2003)
IMPORTANT: See reverse side for penalty information, if filed after February 02, 2004.
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