Form W-1 - Employer'S Return Of Tax Withheld

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EMPLOYER’S RETURN OF TAX WITHHELD
(FORM W-1)
1. Payroll subject to Bedford Tax: NOTE: 401k – deferred com-
MAKE CHECK OR MONEY ORDER TO:
pensation annuity payments of any kind ARE taxable
$ .........................
CITY OF BEDFORD TAX DEPARTMENT
2. Bedford Tax due at __2.25%____________
$ .........................
P.O. BOX 92636-T
3. Adjustments to tax: (attach statement)
$ .........................
CLEVELAND, OHIO 44190-2636
1
4. Penalty/Interest: Penalty=15% per mo., Interest =1
/
% per mo. $ .........................
2
(888) 232-1600 or (440) 735-6505
5. TOTAL DUE WITH THIS FORM:
$ .........................
TAX YEAR: ___________ PAYMENT ENCLOSED FOR:
JAN FEB MAR.................................... DUE 4/30
FEDERAL I.D./SSN
APR MAY JUNE .................................. DUE 7/31
JUL AUG SEPT ................................. DUE 10/31
OCT NOV DEC.................................... DUE 1/31
MONTH OF___________________________
MONTHLY REPORTS DUE BY 20TH OF FOLLOWING MONTH
( _______ ) __________ – _______________
PHONE
___________________________________
(SIGNED)
OFFICIAL
____________________________________
TITLE
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS ABOVE
I HEREBY CERTIFY THAT THE INFORMATION AND
ORIGINAL – RETURN THIS COPY WITH PAYMENT
STATEMENTS CONTAINED HEREIN ARE TRUE AND CORRECT
EMPLOYER’S RETURN OF TAX WITHHELD
(FORM W-1)
1. Payroll subject to Bedford Tax: NOTE: 401k – deferred com-
MAKE CHECK OR MONEY ORDER TO:
pensation annuity payments of any kind ARE taxable
$ .........................
CITY OF BEDFORD TAX DEPARTMENT
2. Bedford Tax due at ______________
$ .........................
P.O. BOX 92636-T
3. Adjustments to tax: (attach statement)
$ .........................
CLEVELAND, OHIO 44190-2636
1
4. Penalty/Interest: Penalty=15% per mo., Interest =1
/
% per mo. $ .........................
2
(888) 232-1600 or (440) 735-6505
5. TOTAL DUE WITH THIS FORM:
$ .........................
TAX YEAR: ___________ PAYMENT ENCLOSED FOR:
JAN FEB MAR.................................... DUE 4/30
FEDERAL I.D./SSN
APR MAY JUNE .................................. DUE 7/31
JUL AUG SEPT ................................. DUE 10/31
OCT NOV DEC.................................... DUE 1/31
MONTH OF___________________________
MONTHLY REPORTS DUE BY 20TH OF FOLLOWING MONTH
( _______ ) __________ – _______________
PHONE
___________________________________
(SIGNED)
OFFICIAL
____________________________________
TITLE
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS ABOVE
I HEREBY CERTIFY THAT THE INFORMATION AND
DUPLICATE – RETAIN FOR YOUR RECORDS
STATEMENTS CONTAINED HEREIN ARE TRUE AND CORRECT

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