Form W-3 - Mantua Village Tax Reconciliation - 2010
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1FORM W-3 Mantua Village Tax Reconciliation
Page 1 of 1
FORM W-3 ~ MANTUA VILLAGE TAX RECONCILIATION ~ 2010
Employer's Name, address, and FEIN number
File with:
Village of Mantua
Income Tax Dept.
P.O. Box 775
Mantua, Ohio 44255
INSTRUCTIONS
If item 7 indicates overpayment and refund is desired, attach explanation. If additional tax due is
indicated, enclose payment when filing.
The tax ordinance requires the annual preparation and filing of this report, from all employers subject to
the tax, on or before January 31, 2011.
Other information required to be submitted with this report is the name and address of each employee
completely, or only in part, subject to tax during the tax year, the total gross earnings of each such
employee and the amount of tax withheld from those earnings. If additional space is required, continue
on reverse side, or attach additional sheets. Employers desiring to submit commercially reproduced
copies of federal W-2 or electronic reproductions bearing the required information in either card or listing
form may do so in lieu of the listing form.
1.
Total Number of Employees
_____________________
TOTAL MANTUA INCOME TAX
WITHHELD AND REMITTED
2.
Total Payroll of the Year
$ ____________________
First Quarter (3/31)
$ ____________________
Second Quarter (6/30)
$ ____________________
Third Quarter (9/30)
$ ____________________
3.
Less Payroll Not Subject to
$ ____________________
Fourth Quarter (12/31)
$ ____________________
Tax
$ ____________________
6. Total Remitted for Year
$ ____________________
4.
Payroll Subject to Tax
$ ____________________
7. Overpayment OR
$ ____________________
5.
Withholding Tax Liability,
1 1/2% of Line 4
8. Additional Tax Due
$ ____________________
LIST OF EMPLOYEES
AMOUNT OF TOTAL
AMOUNT OF VILLAGE
Names and Addresses
GROSS EARNINGS
TAX WITHHELD
.
.
.
1/17/2011
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