Form Q-1/2/3/4 - Employer Quarterly Return Of Withholding Tax - 2004 Page 2

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Q-4
EMPLOYER QUARTERLY RETURN OF WITHHOLDING TAX
CINCINNATI INCOME TAX BUREAU
2004
P O BOX 640770
2003
CINCINNATI OH 45264-0770
FOR OFFICIAL USE ONLY
ACCOUNT #:
FED ID#:
Enter your name and address here
SSN#:
2.10%
TAX RATE:
2004
QUARTER ENDING: DECEMBER 31, 2003
2005
DUE DATE: JANUARY 31, 2004
AMOUNT DUE: $
DATE
PHONE (
)_________________SIGNATURE______________________TITLE____________
------------------------------------------------------------------------------------------------------------------------------------------------
Section 311-31 of the Cincinnati Municipal Code states:
Monthly payment of taxes withheld shall be made by an employer if the taxes deducted in the prior
calendar year were more than three thousand six hundred dollars ($3,600.00), or if such deductions
otherwise normally exceed three hundred dollars ($300.00) per month. Such payments shall be made
to the city within fifteen days after the close of each calendar month.

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