Form Eqr - Employer'S Municipal Tax Withholding Statement - City Of Hilliard, Ohio
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1.
.
Form
EQR
EMPLOYER'S MUNICIPAL T A X WITHHOLDING STATEMENT
6 %%l\Lk$.K:8
I HAVE
EXAMINED THIS RETURN
AND
TO THE BEST
OF MY
KNOWLEDGE IT IS CORRECT
MAKE CHECKS PAYABLE TO
CITY OF HILLIARD DIVISION OF TAXATION
3800
MUNlClPAL WAY
HILLIARD, OHIO
43026-I696
SKNWURE
TmE
OATE
' .
UNES I,
2.
AND 4 MUST BE COMPLETED
FmNT
NAME
PRINT
lllLE
1.
TOTAL WAGES SUBJECT
$
ACCOUNT #
TO WITHHOLDING TAX
*FED 1.D.t
2. AMOUNT OF TAX
J
WITHHELD (LINE
1
X 2%)
Name
.
f
3. ADJUSTMENTS
Address
a
4.
BALANCE DUE AND PAID
Telephone number
Contact person
Please check one of the following
quarterly
-
monthly
semi-monthly
Enter date's this payment applies to
-
Rease check here if this is a NEW ACCOUNT (ld payment)
If so, please complete the following.
Please check which of the following applies to this payment and give us the address so
we can verify the taxing jurisdiction.
Business located in Hilliard
Address:
Work done or a service performed in Hilliard
Address:
A courtesy withholding for a Hilliard resident
Address:
Other
Address:
\
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