Rds Monthly Occupational Tax Return Form

RDS Monthly Occupational Tax Return

Remit To:

PO Box 830725

Birmingham, AL 35283-0725

(205) 324-0088

(800) 556-7274

MAKE CHECK PAYABLE TO: Tax Trust Acct.

Enter your check amount here.

$

__________________________________________

RDS Account #:

Please Mark the Period you are Filing on This Return

Year: 20___

Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Filing for Tax Period :

th

NOTE: This return must be postmarked by the 20

of the following month to be considered timely and avoid late penalties.

Jurisdiction

Jurisdiction

Gross Wages

# of

Fee Rate

Fee Due

Penalty & Interest

Net Fee Due

Code

Employees

*Requirement for

REQUIRED

Tuskegee

66-66

10% Penalty; 6% interest per annum

9756

Beaverton

1%

10% Penalty; 6% interest per annum

9024

Guin

1%

10% Penalty; 12% interest per annum;

9000

Haleyville

1%

$10.00 minimum

10% Penalty; 12% interest per annum;

9359

Hamilton

1%

$10.00 minimum

5% Penalty; 12% interest per annum;

1%

7044

Macon

$250.00 minimum

County

10% Penalty; 12% interest per annum; $3.00

9375

Midfield

1%

minimum

st

10% Penalty for 1

month; Additional 2% for

9677

Mosses

1%

each month or part of month after; Max 28%;

Minimum $3.00

10% Penalty; 6% interest per annum; $1.00

9702

Shorter

minimum

1%

10% Penalty; 18% interest per annum;

9392

Sulligent

1%

$50.00 minimum

10% Penalty; 12% interest per annum;

½%

9625

Tarrant

$25.00 minimum

5% Penalty; 12% interest per annum; $25.00

9335

Tuskegee

3%

minimum; Max 25%

I declare, under penalties of perjury, that this return (and any accompanying schedules) has been examined by me and to the best of my knowledge is true, correct and complete.

Signed:__________________________________________ Date:_____________________ FEIN:__________________________________

Print Name _____________________________________________Email Address ________________________Telephone # __________________________

FORM DISCLAIMER:

Please note that the administration and rate changes on the RDS Advisory and RDS tax forms are updated once the required information has been received, verified, and validated in compliance with RDS

policy. Any information received before or after the publication of an RDS Advisory or tax form will not be guaranteed to appear on said forms until all such requirements have been met. RDS is not responsible for incorrect information

and/or improper use of the information provided. All updates are completed on a timely basis once the requirements have been met. For the most current RDS administration and/or rate information provided, please visit our website

at

RETURNED CHECK DISCLAIMER: When you make a payment by check, you authorize us to use information from your check to make a one-time electronic fund transfer from your checking account according to the terms of your

check or to process that transaction as a check. When we use your check to make an electronic fund transfer, funds may be withdrawn from your checking account as soon as the same day we receive your payment, and you will not

receive your check back from your financial institution. If there are insufficient funds in your checking account, you authorize us to charge a Returned Payment Fee in the amount set forth below and collect that amount through an

electronic fund transfer from your checking account, if permitted by applicable law. IF YOUR CHECK OR OTHER PAYMENT IS RETURNED UNPAID by your bank, we may, if permitted by applicable law, charge a Returned Payment

Fee of $ 50 in KY and VA; $40 in DE and MS; $ 35 in MD; $30 in AL, OH, SC, TN, and TX; $25 in AR, IL, MO, NC and WV; $20 in IN; the greater of 5% of the check or (i) $30 in GA or (ii) $25 in LA; the greater of 5% of the check or

(i) $25 if the check is under $50, (ii) $30 if the check is between $50 and $300 or (iii) $40 if the check is over $300 in FL. Effective July 1, 2010, each returned item received by RDS due to insufficient funds will be electronically

represented to the presenters’ bank no more than two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue due to the resubmission of the returned item.

RDS Occupational Withholding Tax – Updated2/2011