Form Ba-12 - Employer'S Return Of Tax Withheld - Return With Payment 2010 Page 2
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5CITY OF ZANESVILLE EMPLOYER’S RETURN OF TAX WITHHELD
RETURN WITH PAYMENT
MAKE CHECKS PAYABLE TO:
1. NUMBER OF TAXABLE EMPLOYEES
2. TAXABLE EARNINGS
$
ZANESVILLE CITY INCOME TAX
3. ACTUAL TAX WITHHELD AT 1.9% (.019)
$
401 MARKET STREET
4. ADJUSTMENTS OF TAX FOR PRIOR PERIOD
$
ZANESVILLE, OH 43701-3576
5. INTEREST AND PENALTY (3 1/2% PER MONTH)
$
6. TOTAL INCLUDING INTEREST AND PENALTY IF DUE
$
FOR THE PERIOD ENDING
APRIL 30, 2010
DUE ON OR BEFORE
MAY 31, 2010
I hereby certify that the information and
statements herein are true and correct
SIGNED______________________________________________
OFFICIAL TITLE_______________________________________
FEDERAL ID NO_______________________________________
PHONE NO___________________________________________
BA-12
NOTIFY TAX OFFICE PROMPTLY OF ANY CHANGE IN OWNERSHIP, NAME OR ADDRESS
CITY OF ZANESVILLE EMPLOYER’S RETURN OF TAX WITHHELD
RETURN WITH PAYMENT
MAKE CHECKS PAYABLE TO:
1. NUMBER OF TAXABLE EMPLOYEES
2. TAXABLE EARNINGS
$
ZANESVILLE CITY INCOME TAX
3. ACTUAL TAX WITHHELD AT 1.9% (.019)
$
401 MARKET STREET
4. ADJUSTMENTS OF TAX FOR PRIOR PERIOD
$
ZANESVILLE, OH 43701-3576
5. INTEREST AND PENALTY (3 1/2% PER MONTH)
$
6. TOTAL INCLUDING INTEREST AND PENALTY IF DUE
$
FOR THE PERIOD ENDING
MAY 31, 2010
DUE ON OR BEFORE
JUNE 30, 2010
I hereby certify that the information and
statements herein are true and correct
SIGNED______________________________________________
OFFICIAL TITLE_______________________________________
FEDERAL ID NO_______________________________________
PHONE NO___________________________________________
BA-12
NOTIFY TAX OFFICE PROMPTLY OF ANY CHANGE IN OWNERSHIP, NAME OR ADDRESS
CITY OF ZANESVILLE EMPLOYER’S RETURN OF TAX WITHHELD
RETURN WITH PAYMENT
MAKE CHECKS PAYABLE TO:
1. NUMBER OF TAXABLE EMPLOYEES
2. TAXABLE EARNINGS
$
ZANESVILLE CITY INCOME TAX
3. ACTUAL TAX WITHHELD AT 1.9% (.019)
$
401 MARKET STREET
4. ADJUSTMENTS OF TAX FOR PRIOR PERIOD
$
ZANESVILLE, OH 43701-3576
5. INTEREST AND PENALTY (3 1/2% PER MONTH)
$
6. TOTAL INCLUDING INTEREST AND PENALTY IF DUE
$
FOR THE PERIOD ENDING
JUNE 30, 2010
DUE ON OR BEFORE
JULY 31, 2010
I hereby certify that the information and
statements herein are true and correct
SIGNED___________________________________________
OFFICIAL TITLE____________________________________
FEDERAL ID NO____________________________________
PHONE NO________________________________________
NOTIFY TAX OFFICE PROMPTLY OF ANY CHANGE IN OWNERSHIP, NAME OR ADDRESS
BA-12
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