Form W-3 - Withholding Tax Reconciliation - Village Of Addyston printable pdf download

WITHHOLDING TAX RECONCILIATION

FOR THE YEAR 20_____

Village of Addyston

Income Tax Bureau

Total Addyston Income Tax Withheld During The Year For:

FORM W-3

January $ ____________________ July

$ ___________________

February $ ____________________

August $ ___________________

1. Total number of employees

March $ ____________________

September

$ ___________________

April $ ____________________

October

$ ___________________

2. Total payroll for the year

May $ ____________________

November

$ ___________________

3. Less payroll not subject to tax

June $ ____________________

December

$ ___________________

4. Payroll subject to tax

6. Total Remitted for the Year . . . . . . . . . . . . . . . . . . .$ ___________________

7. Overpayment $ _____________ or additional tax $ ___________________

5. Withholding tax liability @ 1% of line 4

Due

EMPLOYER'S NAME, ADDRESS AND ACCOUNT NUMBER

Do not write in the space below

TAX YEAR

INSTRUCTIONS

If item 7 above indicates overpayment and refund is desired, attach explanation and request to this Form. If additional tax is indicated, attach payment

when filing.

The tax ordinance requires the annual preparation and filing of this report from all employers subject to the tax. Reports must be completed and mailed

to the Addyston Income Tax Bureau, 235 Main Street, Addyston, Ohio 45002 on or before April 30 of next year.

Other information required to be submitted with this report is the name and address of each employee subject to tax during the entire year; the total

gross earnings of each such employee and the amount of Addyston Tax withheld from those earnings. The form below is provided for use of employers

in submitting this information. If additional space is required, continue on reverse side, or attach additional sheets of this same size. Employers desiring

to submit commercially reproduced copies of Federal Forms W-2 or electronic reproductions bearing the required information in either card of listing

form may do so in lieu of the listing form below. Additional forms, for your own records, can be secured from the Tax Bureau upon request.

TOTAL EARNINGS

ADDYSTON

NAME AND ADDRESS OF EMPLOYEE

FOR THE YEAR

TAX WITHHELD

TOTAL FOR THIS PAGE

TOTAL ALL PAGES