Return Of City Service Fee Withheld Form

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City of Huntington
___________
WEST VIRGINIA
RETURN OF CITY SERVICE FEE WITHHELD
Division of Finance
City Hall, P.O. Box 1659, zip 25717
Phone 304.696.5527
Fax 304.696.4493
No. of Employees
PERIOD ENDED
DUE DATE
at the end of Period
User Fee withheld
Signature:
Date:
this Period
Adjustments Made
Employer’s Account Number, Name and Address
(Pluse or Minus)
User Fee due this
Period
Penalty
(5% After due Date Per
Qtr)
TOTAL
REMITTANCE

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