Form W3q/m - Reconciliation Of Monthly And Quarterly Returns Of Tax Withheld
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1COPIES OF W-2’S OR COMPUTER LIST MUST ACCOMPANY THIS FORM
CITY OF NORTH RIDGEVILLE, OHIO
RECONCILIATION OF MONTHLY AND QUARTERLY RETURNS OF TAX WITHHELD FOR NORTH RIDGEVILLE
For CALENDAR YEAR
Form W3Q/M
WITH STATEMENTS OF WAGES SUBJECT TO TAX
1. NUMBER OF EMPLOYEES REPRESENTED BY W-2 STATEMENTS
TAX WITHHELD AND PAID FROM WAGES DURING YEAR REPORTED
OR PAYROLL TABULATION (ATTACHED) ............................................
BY MONTHLY/QUARTERLY (W1) RETURNS OF TAX WITHHELD
2. TOTAL PAYROLL TAXABLE TO NORTH RIDGEVILLE ......................
$
JANUARY
APRIL
JULY
OCTOBER
$
$
$
$
3. TAX RATE OF 1% ......................................................................................
$
FEBRUARY
MAY
AUGUST
NOVEMBER
$
$
$
$
MARCH
JUNE
SEPTEMBER
DECEMBER
$
$
$
$
1
ST
QUARTER
2
ND
QUARTER
3
RD
QUARTER
4
TH
QUARTER
$
$
$
$
Federal ID No.
4. TOTAL PAID DURING YEAR
$
IF LINE 4 IS NOT EQUAL TO LINE 3, ATTACH
EXPLANATION OR REMIT AMOUNT DUE AND
DUE ON OR BEFORE JANUARY 31
ENTER ON LINE 5.
5.
ADJUSTMENT AMOUNT DUE
WITH RECONCILIATION
$
SIGNATURE
TITLE
(
)
6.
TOTAL LIABILITY
$
PHONE NO.
DATE
RETURN THIS COPY
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