Form W-1 - Employer'S Return Of Tax Withheld Page 2
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1
2Form W-1
Return with Payment
EMPLOYER’S RETURN OF TAX WITHHELD
Vandalia • Brookville • Union • Clayton • West Milton • Butler Township JEDD • Butler Township JEDZ • Clay Township-Clayton JEDD
CITY OF
CITY OF
CITY OF
CITY OF
VILLAGE OF
VANDALIA
BROOKVILLE
UNION
CLAYTON
WEST MILTON
1. Payroll this period ……………………………….
2%
1.75%
1%
1.5%
1.5%
2. Tax ………………………………………………
3. Adjustment (provide explanation) ………………
4. Amount remitted (each city) …………………….
BUTLER TWP
BUTLER TWP
CLAY TWP-
JEDD
JEDZ
CLAYTON JEDD
1. Payroll this period ……………………………….
2%
1%
1.5%
2. Tax ………………………………………………
3. Adjustment (provide explanation) ………………
4. Amount remitted (each city) …………………….
TOTAL REMITTANCE …………………………………… $
I hereby certify that the information and statements contained herein are true and correct.
For period ending __________________ Due on or before ___________________
Account #_________________________
Federal ID # _______________________
Signed _________________________________________________________________
Official Title ___________________________________ Date ____________________
Name ________________________________________________________________
Please make check or money order payable to: CITY OF VANDALIA
Address ______________________________________________________________
Mail to: VANDALIA TAX OFFICE
_____________________________________________________________________
PO BOX 727
Phone # ______________________________________________________________
VANDALIA, OH 45377-0727
Is this a courtesy withholding? …………………………………
Yes /
No
ONLINE FILING AND PAYMENTS CAN BE
Is this a final return? …………………………………………….
Yes /
No
MADE ON OUR WEBSITE:
Amended? ………………………………………………………
Yes /
No
Please attach explanation if necessary.
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