Form W-3 - Withholding Tax Reconciliation - Ohio
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1
2WITHHOLDING TAX RECONCILIATION – PAGE 1
FOR TAX YEAR ENDING
2004
SUBMIT BY FEBRUARY 28. W-2’S MUST BE ATTACHED
Phone (937) 415-2240
BOTH PAGE 1 & PAGE 2 OF THIS RECONCILIATION MUST BE COMPLETED & SUBMITTED BY FEBRUARY 28.
CITY OF
CITY OF
CITY OF
VANDALIA
ENGLEWOOD
BROOKVILLE
TOTAL
1) Total number of W-2’s attached
2) Total payroll for year
$
$
$
$
3) Less payroll not subject to tax
$
$
$
$
4) Payroll subject to tax
$
$
$
$
5) Withholding tax liability
@ 1.75% of line 4
$
$
$
$
NO REFUND WITH THIS FORM. SEE INSTRUCTIONS.
I hereby certify that the information and statements contained are true
and correct.
Signed
Title
Fed. ID No.
Date
M A I L TO :
VA N D A L I A TA X O F F I C E
P O B O X 7 2 7
VA N D A L I A , O H 4 5 3 7 7 - 0 7 2 7
Form W-3
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