Reconciliation Of City Income Tax Withheld And Transmittal Of W-2 Forms - Monthly/quarterly Payments - City Of Centerville

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CITY OF
Reconciliation of City Income Tax Withheld and Transmittal of W-2 Forms
Income Tax Department
20__
MONTHLY PAYMENTS
QUARTERLY PAYMENTS
JAN.
JULY
1st Qtr.
2nd Qtr.
FEB.
AUG.
3rd Qtr.
4th Qtr.
MAR.
SEPT.
1) Number of W-2 Forms attached
APRIL
OCT.
2) Total Taxable Wages as reported on
MAY
NOV.
$
W-2 Forms attached
JUNE
DEC.
3) City Tax Rate
Federal Employer
$
4) Tax Liability
Identification No.
5) Total City Tax withheld as remitted
on Return of Income Tax Withheld
$
forms for 20__
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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