Form W-1 - Return Of Income Tax Withheld - Village Of Octa Income Tax, Ohio

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White - REMITTANCE COPY
Form W-1
Village of Octa Income Tax
Canary - Employee Copy
File with
RETURN OF INCOME TAX WITHHELD
Village of Octa
For period from ___________________________ to ___________________________
Income Tax Dept.
VILLAGE OF OCTA
No. of taxable employees*
INCOME TAX DEPARTMENT
P.O. Box 63, 8029 Allen Street • Milledgeville, Ohio 43142
1. TOTAL SALARIES (WAGES,
6. TOTAL PAYABLE HEREWITH MAKE CHECK
3. TAXABLE EARNINGS
5. ADJUSTMENTS TO
4. TAXES WITHHELD FOR
2. NON-TAXABLE
COMMISSIONS, BONUSES,
OR MONEY ORDER PAYABLE TO THE
(SUBTRACT LINE 2 FROM LINE 1)
PRIOR RETURNS
OCTA
ETC.)
VILLAGE OF OCTA
I declare that this return has been examined by me, and to the best of my knowledge and belief is a true, correct and
complete return, made in good faith, pursuant to the village of Octa Income Tax Ordinance and Regulations.
(Signed) ..........................................................................................................................
(Corporation, Business or Trade Name)
By .............................................................................. Date ............................................
Due on or Before ______________________ Penalty
_____________
Interest
_____________
Total
_____________
Identification Number, Name and Address
Tax Rate: _____________
* If you did not have any employees this period, please so state and return this form.
White - REMITTANCE COPY
Form W-1
Village of Octa Income Tax
Canary - Employee Copy
File with
RETURN OF INCOME TAX WITHHELD
Village of Octa
For period from ___________________________ to ___________________________
Income Tax Dept.
VILLAGE OF OCTA
No. of taxable employees*
INCOME TAX DEPARTMENT
P.O. Box 63, 8029 Allen Street • Milledgeville, Ohio 43142
1. TOTAL SALARIES (WAGES,
6. TOTAL PAYABLE HEREWITH MAKE CHECK
3. TAXABLE EARNINGS
5. ADJUSTMENTS TO
4. TAXES WITHHELD FOR
2. NON-TAXABLE
COMMISSIONS, BONUSES,
OR MONEY ORDER PAYABLE TO THE
(SUBTRACT LINE 2 FROM LINE 1)
PRIOR RETURNS
OCTA
ETC.)
VILLAGE OF OCTA
I declare that this return has been examined by me, and to the best of my knowledge and belief is a true, correct and
complete return, made in good faith, pursuant to the village of Octa Income Tax Ordinance and Regulations.
(Signed) ..........................................................................................................................
(Corporation, Business or Trade Name)
By .............................................................................. Date ............................................
Due on or Before ______________________ Penalty
_____________
Interest
_____________
Total
_____________
Identification Number, Name and Address
Tax Rate: _____________
* If you did not have any employees this period, please so state and return this form.

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