Form W1 12 - Employer'S Withholding - Monthly - 2005 Page 3
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6FORM W1
12
3806268794
EMPLOYER'S WITHHOLDING - MONTHLY
1
1. Number of Taxable Employees. . . . . . . . . . . . . . . . . . . . . . . . .
Tax Year 2005
2. Total Salaries, Wages, Commissions and other
I hereby certify that the information and statements
Compensation paid all employees. . . . . . . . . . . . . . . . . . . . . . . . .
2
contained here in and in any schedules or exhibits
attached are true and correct.
Signed
3. Taxable Earnings (from line 2). . . . . . . . . . . . . . . . . . . . . . . . . .
3
Title
Date
4
4. Actual Tax Withheld at 1.200 %. . . . . . . . . . . . . . . . . . . . . . . . .
THIS RETURN MUST BE FILED ON
5
5. Adjustments of Tax for Prior Period. . . . . . . . . . . . . . . . . . . . . .
OR BEFORE
AUGUST
15, 2005
6
6. Interest. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MAKE CHECK OR MONEY ORDER TO:
7
7. Penalty. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
VILLAGE OF EVENDALE
8. Total (Include Interest and Penalty if Due). . . . . . . . . . . . . . . . .
10500 READING RD
Name
EVENDALE OH 45241
And
Voice 513-563-2671
Fax 513-563-2244
Period Ending JULY
Address
TAX ID
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS.
FORM W1
12
3806268795
EMPLOYER'S WITHHOLDING - MONTHLY
1
1. Number of Taxable Employees. . . . . . . . . . . . . . . . . . . . . . . . .
Tax Year 2005
2. Total Salaries, Wages, Commissions and other
I hereby certify that the information and statements
Compensation paid all employees. . . . . . . . . . . . . . . . . . . . . . . . .
2
contained here in and in any schedules or exhibits
attached are true and correct.
Signed
3. Taxable Earnings (from line 2). . . . . . . . . . . . . . . . . . . . . . . . . .
3
Title
Date
4
4. Actual Tax Withheld at 1.200 %. . . . . . . . . . . . . . . . . . . . . . . . .
THIS RETURN MUST BE FILED ON
5
5. Adjustments of Tax for Prior Period. . . . . . . . . . . . . . . . . . . . . .
OR BEFORE
SEPTEMBER
15, 2005
6
6. Interest. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MAKE CHECK OR MONEY ORDER TO:
7
7. Penalty. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
VILLAGE OF EVENDALE
8. Total (Include Interest and Penalty if Due). . . . . . . . . . . . . . . . .
10500 READING RD
Name
EVENDALE OH 45241
And
Voice 513-563-2671
Fax 513-563-2244
Period Ending AUGUST
Address
TAX ID
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS.
FORM W1
12
3806268796
EMPLOYER'S WITHHOLDING - MONTHLY
1
1. Number of Taxable Employees. . . . . . . . . . . . . . . . . . . . . . . . .
Tax Year 2005
2. Total Salaries, Wages, Commissions and other
I hereby certify that the information and statements
Compensation paid all employees. . . . . . . . . . . . . . . . . . . . . . . . .
2
contained here in and in any schedules or exhibits
attached are true and correct.
Signed
3. Taxable Earnings (from line 2). . . . . . . . . . . . . . . . . . . . . . . . . .
3
Title
Date
4
4. Actual Tax Withheld at 1.200 %. . . . . . . . . . . . . . . . . . . . . . . . .
THIS RETURN MUST BE FILED ON
5
5. Adjustments of Tax for Prior Period. . . . . . . . . . . . . . . . . . . . . .
OR BEFORE
OCTOBER
15, 2005
6
6. Interest. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MAKE CHECK OR MONEY ORDER TO:
7
7. Penalty. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
VILLAGE OF EVENDALE
8. Total (Include Interest and Penalty if Due). . . . . . . . . . . . . . . . .
10500 READING RD
Name
EVENDALE OH 45241
And
Voice 513-563-2671
Fax 513-563-2244
Period Ending SEPTEMBER
Address
TAX ID
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS.
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