Form Eqr - Employer'S Quarterly Return Of Tax Withheld

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C C I I T T Y Y O O F F O O N N T T A A R R I I O O , , O O H H I I O O I I N N C C O O M M E E T T A A X X
I I n n s s t t r r u u c c t t i i o o n n s s o o n n R R e e v v e e r r s s e e
s s i i d d e e o o f f T T a a x x p p a a y y e e r r ’ ’ s s C C o o p p y y
E E M M P P L L O O Y Y E E R R ’ ’ S S Q Q U U A A R R T T E E R R L L Y Y R R E E T T U U R R N N O O F F T T A A X X W W I I T T H H H H E E L L D D
F F o o r r m m E E Q Q R R
D D O O L L L L A A R R S S
C C E E N N T T S S
I hereby certify that the information and statements
Income Tax Rate:
contained herein are true and correct.
Taxable Earnings paid all Employees subject to
1.
Ontario, Ohio City Income Tax.............................................................
$
(Signed)
Exclude under 18’s.
Actual Tax Withheld this Quarter for City Income Tax..........................
2.
$
(Title)
Date
Adjustment of Tax for prior quarter (see instructions)....................
3.
THIS RETURN MUST BE FILED
4.
Interest............................................................................................
ON OR BEFORE THE DUE DATE SHOWN BELOW
5.
MAKE CHECK OR MONEY ORDER PAYABLE TO
Penalty............................................................................................
(
)
If no withholding - return form stating NONE
C C I I T T Y Y O O F F O O N N T T A A R R I I O O , , O O H H I I O O - I I N N C C O O M M E E T T A A X X
TOTAL
6.
.................
$
If business ceased or job completed so advise.
MAIL TO:
C C I I T T Y Y O O F F O O N N T T A A R R I I O O , , O O H H I I O O
I I N N C C O O M M E E T T A A X X D D E E P P T T . .
P.O. BOX 166
FOR MONTHS OF
ONTARIO, OHIO 44862
DUE ON OR BEFORE
Notify Income Tax Division promptly of any change in ownership or name and
If receipt is desired, return Taxpayer’s Copy of this
address shown above.
form and enclose self-addressed, stamped envelope.
RETURN PART 1 — KEEP PART 2 FOR YOUR RECORDS.

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