Form W-1 - Employer'S Quarterly Return Of Tax Withheld - Village Of New Lebanon, Ohio Page 17

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VILLAGE OF NEW LEBANON ANNUAL
ALL SECTIONS
JANUARY
JULY
RECONCILIATION RETURN
MUST BE COMPLETED
FEBRUARY
AUGUST
1. TOTAL NUMBER
W-2’S MUST BE ATTACHED
NEW LEBANON W-2’S
MARCH
SEPTEMBER
MAIL TO:
INCOME TAX DEPARTMENT
2. NEW LEBANON WAGES
VILLAGE OF NEW LEBANON
SUBJECT TO
198 S CLAYTON RD
WITHHOLDING TAX
$
1ST QUARTER
3RD QUARTER
NEW LEBANON, OHIO 45345
3. AMOUNT OF NEW LEBANON
PHONE: (937) 687-1341
TAX WITHHELD
$
APRIL
OCTOBER
FOR TAX YEAR ENDING 2014
DUE FEBRUARY 28, 2015
4. AMOUNT OF
RESIDENCE
MAY
NOVEMBER
PAYMENT ENCLOSED
TAX WITHHELD
$
REFUND REQUESTED
5. ADJUSTMENTS
$
JUNE
DECEMBER
SEE INSTRUCTIONS
6. TOTAL NEW LEBANON
TAX DUE
$
2ND QUARTER
4TH QUARTER
NAME:
FIN:
I hereby certify that the information and statements contained herein are true and correct.
Signed
Title
Federal ID no.
Date
Phone no.
FORM W3

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