Form Csf-4 - Employer Worksheet - City Of Charleston
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1Employer Worksheet
CSF-4
CITY OF CHARLESTON, WV
Form
City Service Fee
**See instructions below.
(Rev.-1-2008
Charleston City Collector
Please type or print legibly.
Number of Employees
and
Self Employed
Persons
Period Ended
Due Date
Included
Employer Name
Employer's Identification Number
Mailing Address (number and street)
Phone Number
City, State, and Zip Code
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Basis of Computation
(choose one)
$2.00
$4.00
$4.33
$8.66
A
B
C
D
Number of
Number of Self-
Employees in
Employed in
Pay Period or Week Ending Date
Charleston
Charleston
Total
a
b
c
c
d
e
f
g
h
i
j
k
l
m
X
TOTAL
By signing below, I attest I have prepared this Employer Worksheet (CSF-4), and it is true and accurate to the best
of my ability. I also understand this form is to be retained by the Employer
Type or Print Name and Title of Preparer
Preparer Signature and Date
Instructions for Employer Worksheet
This form must be completed based on the Basis of Computation method above chosen by the Employer disclosed
on the worksheet, as explained in the administrative regulations. The dates entered in lines "a" through "m", Column
A shall be the ending dates for each weekly, bi-weekly, semi-monthly, or monthly pay period, depending on the
period used and elected by the Employer, throughout the entire reporting period. The total in line X, Column D is
multiplied by the appropriate rate (depending upon the Basis of Computation withholding method) to determine the
total City Service Fee to be remitted for the reporting period. This form must be signed and retained by the
Employer. For additional information, please refer to the City Service Fee Administrative Regulations available on
the city's website at , or by calling or emailing the City Collector's Office at 348-8024 or
.
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Parent category: Financial