Form Q-1/2/3/4 - Employer Quarterly Return Of Withholding Tax - 2003 Page 2

Q-4

EMPLOYER QUARTERLY RETURN OF WITHHOLDING TAX

CINCINNATI INCOME TAX BUREAU

P O BOX 640770

2003

CINCINNATI OH 45264-0770

FOR OFFICIAL USE ONLY

ACCOUNT #:

FED ID#:

Enter your name and address here

SSN#:

TAX RATE:

QUARTER ENDING: DECEMBER 31, 2003

DUE DATE: JANUARY 31, 2004

AMOUNT DUE: $

DATE

PHONE (

)_________________SIGNATURE______________________TITLE____________

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Section 311-31 of the Cincinnati Municipal Code states:

Monthly payment of taxes withheld shall be made by an employer if the taxes deducted in the prior

calendar year were more than three thousand six hundred dollars ($3,600.00), or if such deductions

otherwise normally exceed three hundred dollars ($300.00) per month. Such payments shall be made

to the city within fifteen days after the close of each calendar month.

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Parent category: Financial