Form W-1 - Employers Return Of Tax Withheld

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Form
EMPLOYERS RETURN OF TAX WITHHELD
W—1
MUNROE FALLS, OHIO — INCOME TAX DEPARTMENT
INSTRUCTIONS ON REVERSE SIDE
$
1. GROSS PAYROLL TAXABLE
I HEREBY CERTIFY that the information and statements contained
2. ACTUAL TAX WITHHELD
herein and any schedules attached are true and correct.
$
THIS REPORT
If payment is past due, see instructions
(Signed)
and complete below.
3. INTEREST
4. PENALTY
(Official Title)
Date
$
5. TOTAL PAID
OWNER, PARTNER, MEMBER, PRESIDENT, TREASURER, AGENT
MAKE CHECK OR MONEY ORDER PAYABLE TO
FED. I.D. NO.
MUNROE FALLS INCOME TAX DEPT.
NAME
PAYABLE AT:
43 MUNROE FALLS AVENUE
ADDRESS
MUNROE FALLS, OHIO 44262-1538
FOR PERIOD ENDING
DUE ON OR BEFORE
THIS RETURN MUST BE FILED ON OR ABOVE
If name or Address is Incorrect Make Necessary Change
DUE DATE AS SHOWN ABOVE

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