Reconcilliation Of City Income Tax Withheld And Transmittal Of W-2 Forms - 2004

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2
CITY OF MASSILLON
Reconcilliation of City Income Tax Withheld and Transmittal of W-2 Forms
Income Tax Department
0
P.O. Box 910
Massillon OH 44648-0910
0
QUARTERLY PAYMENTS
4
1st Qtr. _______
2nd Qtr. _______
MONTHLY PAYMENTS
3rd Qtr. _______
4th Qtr. _______
JAN.
__________
JULY
__________
___________________________________________________
FEB.
__________
AUG.
__________
1) Number of W-2 Forms attached
MAR.
__________
SEPT.
__________
2) Total Taxable Wages as reported on
APRIL __________
OCT.
__________
W-2 Forms attached
$
MAY
__________
NOV.
__________
3) Massillon Tax Rate
x 0.018
JUNE
__________
DEC.
__________
4) Tax Liability
$
Federal Employer
5) Total City Tax withheld as remitted
Identification No.
on Return of Income Tax Withheld
forms for 2004
$
6) Difference between line 4 and 5, other
than rounding.
$
I CERTIFY THAT THE INFORMATION ON THIS RETURN
IS TRUE, CORRECT, AND COMPLETE.
Phone: (
)
Signature
Title
Date

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