Form W-1 - Employer'S Return Of Tax Withheld (Page 2 of 4) in pdf

Form W-1 - Employer'S Return Of Tax Withheld Page 2

CITY OF WEST CARROLLTON

FORM W-1

EMPLOYER’S RETURN OF TAX WITHHELD

DOLLARS

CENTS

I hereby certify that the information and statements

contained herein are true and correct.

1. Employee Earnings subject to West Carrollton Income Tax .. 1.

2. City Income Tax Withheld (2.25%) ......................................... 2.

Signature

3. Adjustments ............................................................................ 3.

4. Penalty ..................................................................................... 4.

Title

Date

5. Interest (.75% per month)........................................................ 5.

THIS RETURN MUST BE FILED ON OR

6. Total Penalty and Interest ........................................................ 6.

BEFORE THE DUE DATE SHOWN

7. Total Due ................................................................................. 7.

MAKE CHECK OR MONEY ORDER PAYABLE TO:

NAME

ID#

CK#

CITY OF WEST CARROLLTON

MAIL TO:

CITY OF WEST CARROLLTON

DIVISION OF TAXATION

300 E. CENTRAL AVE.

FOR MONTH(S) OF

WEST CARROLLTON, OHIO 45449-1810

JANUARY

IMPORTANT

Notify Income Tax Department promptly of any change

DUE ON OR BEFORE

FEBRUARY 15

in ownership or name and address shown above.

Form W-1 - Employer'S Return Of Tax Withheld Page 2