Fillable Form Wht-436 - Quarterly Withholding Reconciliation printable pdf download

Vermont Department of Taxes

PO Box 547 Montpelier, VT 05601-0547

*164361100*

Phone: (802) 828-2551

QUARTERLY WITHHOLDING

VT Form

WHT-436

* 1 6 4 3 6 1 1 0 0 *

RECONCILIATION

Business Name

Federal ID Number

Address

Vermont Account ID

WHT-

For Department Use Only

City

State

ZIP Code

Foreign Country (if not United States)

Reporting Period - Check only ONE. If due date falls on a weekend or holiday, return is due the next business day.

Year being reported (YYYY)

JAN - MAR

APR - JUN

JUL - SEP

OCT - DEC

(due Apr. 25)

(due Jul. 25)

(due Oct. 25)

(due Jan. 25)

A. Number of full-time employees as of the last day of this quarter. . . .A. ________________

B. Number of part-time employees as of the last day of this quarter. . .B. ________________

C. Check here if this is an AMENDED return. . . .

PART I

WAGE WITHHOLDING

1. Total Vermont wages paid this quarter . . . . . . . 1. ____________________________. ____

2. Total Vermont tax withheld from wages this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. ______________________. _____

PART II

NONWAGE WITHHOLDING

3. Total nonwage payments subject to

withholding this quarter . . . . . . . . . . . . . . . . . . . 3. ____________________________. ____

4. Total Vermont tax withheld from nonwage payments this quarter . . . . . . . . . . . . . . . . . . . . . . 4. ______________________. _____

PART III

RECONCILIATION

5. Total Vermont tax withheld this quarter (Add Lines 2 and 4) . . . . . . . . . . . . . . . . . . . . . . . . . . 5. ______________________. _____

6. Total Vermont withholding tax already paid this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. ______________________. _____

7. Refund (if Line 6 is greater than Line 5, subtract Line 5 from Line 6) . . . . . . . . . . . . . . . . . . 7. ______________________. _____

8. Balance Due (if Line 5 is greater than Line 6, subtract Line 6 from Line 5) . . . . . . . . . . . . . .8. ______________________. _____

PART IV

FOR MONTHLY AND SEMI-WEEKLY PAYERS ONLY

9. Total Vermont tax withheld for 1st month of this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. ______________________. _____

10. Total Vermont tax withheld for 2nd month of this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. ______________________. _____

11. Total Vermont tax withheld for 3rd month of this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. ______________________. _____

PART V

SIGNATURE

I declare under the penalties of perjury, this return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the taxpayer, his/her

declaration further provides under 32 V.S.A. §§ 5901-5903 this information has not been and will not be used for any other purpose or made available to any other

person other than for the preparation of this return unless a separate valid consent form is signed by the taxpayer and retained by the preparer.

Signature of Responsible Officer

Date

Daytime telephone

May the Dept. of Taxes discuss this

number (optional)

return with the preparer shown?

(

)

c Yes

c No

Printed name