Employer'S Quarterly Returns Of Tax Withheld Forms
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2CITY OF GALLIPOLIS, OHIO –– EMPLOYER’S RETURN OF TAX WITHHELD
FIRST QUARTER, ___________
FIRST QUARTER, ___________
FIRST QUARTER, ___________
FIRST QUARTER, ___________
DUE APRIL 30
Dollars
Cents
TAX OFFICE USE ONLY
$
1. Total Gross Payroll Subject to City Tax .............................1
TOTAL PAID $ ______________________________
$
2. Actual Tax Withheld for City Income Tax @ 1% ................2
❑ CASH
❑ CHECK _______________________
3. Adjustment of Tax for Prior Period ....................................3
$
RECEIPT #_________________________________
TOTAL
$ $
LATE FEE ________________ TOTAL _________________
*Late filing fee, penalty and interest will be assessed upon late receipt of payment.
PENALTY ________________
MONTHS LATE__________
INTEREST _______________
DATE BILLED ___________
Account # _________ Federal ID # ___________________
Name _______________________________________
Address _______________________________________
City, State, Zip ________________________________________
Submitted By ________________________________________
Date __________ Telephone # ____________________
PLEASE RETURN THIS COPY AND MAKE CHECKS PAYABLE TO THE CITY OF GALLIPOLIS INCOME TAX DEPT.
CITY OF GALLIPOLIS, OHIO –– EMPLOYER’S RETURN OF TAX WITHHELD
SECOND QUARTER, ___________
SECOND QUARTER, ___________
SECOND QUARTER, ___________
SECOND QUARTER, ___________
SECOND QUARTER, ___________
SECOND QUARTER, ___________
DUE JULY 31
Dollars
Cents
TAX OFFICE USE ONLY
$
1. Total Gross Payroll Subject to City Tax .............................1
TOTAL PAID $ ______________________________
$
2. Actual Tax Withheld for City Income Tax @ 1% ................2
❑ CASH
❑ CHECK _______________________
$
3. Adjustment of Tax for Prior Period ....................................3
RECEIPT #_________________________________
TOTAL
$ $
LATE FEE ________________ TOTAL _________________
*Late filing fee, penalty and interest will be assessed upon late receipt of payment.
PENALTY ________________
MONTHS LATE__________
Account # _________ Federal ID # ___________________
INTEREST _______________
DATE BILLED ___________
Name _______________________________________
Address _______________________________________
City, State, Zip ________________________________________
Submitted By ________________________________________
Date __________ Telephone # ____________________
PLEASE RETURN THIS COPY AND MAKE CHECKS PAYABLE TO THE CITY OF GALLIPOLIS INCOME TAX DEPT.
CITY OF GALLIPOLIS, OHIO –– EMPLOYER’S RETURN OF TAX WITHHELD
THIRD QUARTER, ___________
THIRD QUARTER, ___________
THIRD QUARTER, ___________
THIRD QUARTER, ___________
DUE OCTOBER 31
Dollars
Cents
TAX OFFICE USE ONLY
$
1. Total Gross Payroll Subject to City Tax .............................1
TOTAL PAID $ ______________________________
$
2. Actual Tax Withheld for City Income Tax @ 1% ................2
❑ CASH
❑ CHECK _______________________
$
3. Adjustment of Tax for Prior Period ....................................3
RECEIPT #_________________________________
TOTAL
$ $
LATE FEE ________________ TOTAL _________________
*Late filing fee, penalty and interest will be assessed upon late receipt of payment.
PENALTY ________________
MONTHS LATE__________
Account # _________ Federal ID # ___________________
INTEREST _______________
DATE BILLED ___________
Name _______________________________________
Address _______________________________________
City, State, Zip ________________________________________
Submitted By ________________________________________
Date __________ Telephone # ____________________
PLEASE RETURN THIS COPY AND MAKE CHECKS PAYABLE TO THE CITY OF GALLIPOLIS INCOME TAX DEPT.
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