Annual Reconciliation Of Withholding Taxes For Employers Withholding On A Monthly Basis - 2016 Page 2
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2Annual Reconciliation of Withholding Taxes for 2016
For employers withholding on a Quarterly basis
City of Mansfield Income Tax Division
P.O. Box 577, Mansfield, Ohio 44901
Phone: (419)755-9711
Fax: (419)755-9751
Employer Name & Address
Federal EIN:
This reconciliation is due February 28, 2017 with W-2 forms
AND
MUST
100 or more w-2s you
use Digital Storage Media for reporting
Quarterly Amounts Paid:
Number of W-2s enclosed
1st quarter
Total other city compensation paid
2nd quarter
Total other city tax withheld
3rd quarter
Total Mansfield compensation paid
4th quarter
Total Mansfield tax withheld
Total
Total Mansfield tax paid
Mansfield underpaid (enclosed)
Mansfield Overpayment
Refund
Credit to next period
I certify this reconciliation to be true and correct.
Authorized Signature
Printed Name
Title
Phone Number
Contact email address
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