Form W-1 - Employer'S Quarterly Return Of Tax Withheld - Village Of New Lebanon, Ohio Page 10
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18VILLAGE OF NEW LEBANON, OHIO
EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
AMENDED
RETURN WITH PAYMENT
DO NOT ROUND
1. Qualifying wages paid all Employees
I hereby certify that the information and statements
subject to New Lebanon Village Income Tax ................................... 1
contained herein are true and correct.
Is this a courtesy withholding? ......
Yes
(Signed)
Is this a final return? .......................
Yes
No
If yes, attach explanation
2. Taxable Earnings Paid all Employees subject
(Official Title)
to New Lebanon 1% (.01) Income Tax ............................................ 2
3. Adjustment of Tax for prior Period (attach explanation) ................... 3
Date
4. Interest (1% per month)
4
5. Penalty (10%) .................................................................................... 5
Federal ID no.
6. Late filing fee ($5.00 per month – max $60.00) ................................ 6
7. Total – (Lines 2-6) .............................................................................. 7
THIS RETURN MUST BE FILED ON OR
BEFORE THE DUE DATE SHOWN BELOW
NAME AND ADDRESS
FOR THE MONTH OF
JULY
MAKE CHECK OR MONEY ORDER PAYABLE TO
VILLAGE OF NEW LEBANON
DUE ON OR BEFORE
MAIL TO:
AUGUST 31, 2014
VILLAGE OF NEW LEBANON
INCOME TAX DEPT.
198 S CLAYTON RD
NEW LEBANON, OHIO 45345
Notify the Income Tax Department promptly of any change in ownership or name and address shown above.
TELEPHONE (937) 687-1341
FORM W-1
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