Employer Monthly Return Of Withholding Tax Form - 2011 Page 16

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Q04
EMPLOYER QUARTERLY RETURN OF WITHHOLDING TAX
Sylvania Income Tax Division
2011
PO Box 510
Name and Address
Please make necessary corrections
Sylvania, OH 43560
Prepared via Tax Tool
Account #
Federal ID #
Quarter ending: December 31, 2011
Due date: January 31, 2012
Payment amount: $
Signature
Title
Phone

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