CITY OF WEST CARROLLTON
FORM W-1
EMPLOYER’S RETURN OF TAX WITHHELD
DOLLARS
CENTS
MAIL TO:
1.
Employee Earnings
CITY OF WEST CARROLLTON, OHIO
subject to West Carrollton Income Tax
$
INCOME TAX DEPT.
2.
City Income Tax Withheld (2%)
$
P.O. BOX 10
WEST CARROLLTON, OHIO 45449
3.
Adjustments
$
THIS RETURN MUST BE FILED ON OR BEFORE
4.
Penalty
$
THE DUE DATE SHOWN
5.
Interest (1.5% per month)
$
MAKE CHECK OR MONEY ORDER PAYABLE TO
CITY OF WEST CARROLLTON
6.
Total Penalty and Interest
$
I hereby certify that the information and statements
7.
Total Due
$
contained herein are true and correct.
NAME
ID#
PM
CK#
Signature _________________________________
FOR MONTH(S) OF
Title_________________________ Date ________
IMPORTANT
DUE ON OR BEFORE
Notify Income Tax Department promptly of any change in ownership or
name and address shown above.