Annual Reconciliation Form - City Of Bowling Green, Kentucky
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1CITY OF BOWLING GREEN
,
KY
AR
ANNUAL RECONCILIATION
~
~
~
o
"
P.O.
Box
141
0
'OR
'EAR
ENDED
oue
ON
OR
B€FORE
~
z
Bowling
Green,
KY 42 102-14
10
1-
..
~.t\rTUC<t-
(270) 393-3000
C
ITY
OCCUPATIONAL
ACCOUNT NUMBER
••• MAIL TO ABOVE ADDRESS
•••
EMPLOYER ADDRESS
S.S., OR FEO. 1.0./11
C
IT
Y EM I'LOYEE
WITHOLDING
TAX
lao
April
July
Oc1
Feb
May
A
ug
Nov
March
or
I"
Qlr
June o
r
20<1
Qtr
Sept
or
3rd
Qtr
Dec
or
4th
Qlf
NllInbcr of Employees:
Total
City
Ta.~cs
Paid:
$
***
IM
I'OI{TANT·**
The follo\\ing
MUST
be
enclosed
'Copies of
FcdcrJI
Fonns W-2
and
W-J
•
Payroll
Registcr
Anl1uul TOlals
Includi ng All
Deferred
Compcns.1tion
and
Term Life
Insuran
ce
over
$50.000
DUE
FEBRUARY 28
(oho"
,hi,
"""""'''flli""
&)
FEE COM
P
UTAT ION
I
.
Tolal
Gross
Salaries, Wages,
and
OIlier
Compensation
per
box
one of Federal
Form
\V-2
or
W-3.
$,- - - - - -
2.
Add
·Deferred Compensation
Contributed
by
employees.
$,
_ _ _ _ _ _ _ _ _
(i.e. retirement,
profit
sharing,
401K,
etc.)
3.
Add Employee Elections made under
Section
125 of the Internal
$,
_ _ _ _ _ _ _ _ _
Revenue Code
plus other
subject
Welfare, Fringe,
and Benefit Plan Payments .
4
.
Total Gross Compemation
(add
lines
I
through
3.)
5.
Less
Total Gross Compensation
Paid
fo
r
Services Outside
City.
6.
Ta.xable Earnings
inside
City
(subtract line
5
from line
4.)
7.
City
Employee WithholdingTa.x
due
the
City
(line
6
x
1.85%.)
8.
Total City
Employee
Withholding Taxes remitted.
9.
Balance Due (if line
7
is more than
line
8
subtract line
8 from
line 7.)
(No
adjullmml due for min)!" differmce IlIribullble
10
ffactiWlal
,·&rillionl
only.
No ufund.9£ qsdi!
"iP
"tuh from
mlrie! mldr
on
lhi,
Conn
An
amrndM [([Urn for,he
Rtriod
o'·np.!jd
mu!1
bf
filM
!SPlntrly
wilh,
l<1!q
ohxpl,nltjon.
$,- - - - -
$ , - - - - - -
$
,
- - - - - -
$,- - - - - -
$,- - - - -
$,- - - - - -
10.
Interest
@
l
%
percalendarmonth
,
orponionthereof,fromDue
Date
$,
_ _ _ _ _ _ _ _ _
II
.
A
I):l)1nt
nl
of
$
_ _ _ _ _ _ _ _ _
h t
ndostd.
~I:lkt
chtck
))ayablt to
City of Bowling
Grttn.
RETURN
MUST BE
SIGNED.
1
hereby certi fy,
IlIIdcr
penally Qfperjury,
Ihal
the
S1a1emeniS
mu,jc
here in
and
in
my
supporting
schedulc. are
truc.
e<llTec!. 3nd romplc!e
to
the
beS!
of my
knowledge.
Signaturc
T:l
le
Telephone Number
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