Form W-1m - Employer'S Monthly Return Of Tax Withheld - Springfield Income Tax Division

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EMPLOYER’S MONTHLY RETURN OF TAX WITHHELD
CITY OF SPRINGFIELD, OHIO
Form W-1M
Make check payable to Commissioner of Taxation, Springfield, Ohio
(ENTER MONTH & YEAR)
1. Number of Employees_________________________
Return for the month of ______________________________________
2. Total Payroll
2. $
I hereby certify that the information and statements contained herein
and in any schedules or exhibits attached are true and correct.
3. Non-taxable wages (explain ________________________)
3. $
4. Taxable earnings (Line 2 minus Line 3)
4. $
Authorized Signature ______________________________
5. Tax withheld (2% of Line 4)
5. $
Title_____________________________Date ___________
6. Adjustments (explain ______________________________)
6. $
7. Penalty (10, 15, 20 or 25% - see instructions)
7. $
CASHIER IMPRINT IN THIS SPACE IS YOUR RECEIPT
8. Interest (1% per month)
8. $
9. Total
9. $
Print or Type YOUR NAME AND ADDRESS HERE including ACCOUNT NUMBER.
RETURN THIS COPY
Enter Your F.E.I.N or S.S.N. Here
MAIL TO: City of Springfield
Notify Income Tax Division Promptly of Any Change in Name or Address
Income Tax Division
City Hall
P.O. Box 5200
Springfield, OH 45501-5200

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