Return Of Income Tax Withheld - City Of Westerville, Ohio

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City of Westerville, Ohio – Return of Income Tax Withheld
WW-1
(see Page 1 For Instructions)
File With: City of Westerville
1. Tax withheld on income earned in Westerville, (2.0% rate).
$________________
Income Tax Division
2. Residence tax withheld.
$________________
P.O. Box 130
3. Adjustments to Prior Returns.
$________________
Westerville, Ohio 43086-0130
(614) 901-6420
4. Balance Due with this Form. Pay this amount in FULL.
$________________
FAX (614) 901-6820
5. Late Payment Penalty Charge (10%).
$________________
For the Period Ending
6. Late Interest Charge at 1% per month.
$________________
TOTAL DUE
7.
(Make check payable to City of Westerville).
$________________
Due on or Before
Federal I.D. No.
If you did not have any Employees or withheld income
FOR CITY USE ONLY
tax for this period, please indicate and return this form.
I declare that this has been examined by me, and to the best of my knowledge and
belief it is a true, correct and complete return, made in good faith, pursuant to City of
Westerville Income Tax Ordinance and regulations.
SIGNED ___________________________________________________________
TITLE _________________________________________ DATE ______________
Please make corrections if necessary

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