Form Csf-4 - Employer Worksheet West Virginia printable pdf download

Form Csf-4 - Employer Worksheet West Virginia

CITY OF CHARLESTON, W.VA.

Employer Worksheet

CSF-4

Form

City Service Fee

(Rev. 3-2004)

? See instructions below.

Charleston City Collector

Please type or print legibly.

Number of Employees

and Self Employed

Period Ended

Due Date

Persons 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

$1.00

$2.00

$2.16

$4.33

(choose one)

Number of

Number of Self-

Employees in

Employed in

Pay Period or Week Ending Date

Total

Charleston

TOTAL

I prepared this Employer Worksheet. It is to be retained by the Employer and it is true and accurate to the

best of my ability.

Type or print name and title of Preparer

Preparer signature and date

Instructions for Employer Worksheet

This form must be completed based on the computation method chosen by the Employer disclosed in 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 week, bi-weekly pay period, semi-monthly or monthly pay

period, depending on the period used and elected, throughout the entire reporting period. The total in line

X, Column D is multiplied by the appropriate rate (depending upon the withholding computation method)

to determine the total fee to be remitted for the reporting period. This form must be signed and retained

by the Employer. For further information, please refer to the City Service Fee Administrative Regulations

available at

or call the Charleston City Collector’s Office at 304-348-8024.

Form Csf-4 - Employer Worksheet West Virginia

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