Form 35 - Tax Quarterly Payment Voucher Form - 2016 Page 3

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RECORD OF
MUNICIPAL INCOME TAXES WITHHELD RECONCILIATION
GROSS WAGES
TAX WITHHELD
DATE REMITTED
ADJUSTMENTS
JAN
_______________
_______________
_______________
_______________
FEB
_______________
_______________
_______________
_______________
MARCH
_______________
_______________
_______________
_______________
APRIL
_______________
_______________
_______________
_______________
MAY
_______________
_______________
_______________
_______________
JUNE
_______________
_______________
_______________
_______________
JULY
_______________
_______________
_______________
_______________
AUG
_______________
_______________
_______________
_______________
SEPT
_______________
_______________
_______________
_______________
OCT
_______________
_______________
_______________
_______________
NOV
_______________
_______________
_______________
_______________
DEC
_______________
_______________
_______________
_______________
TOTALS
_______________
_______________
_______________
_______________
Rules
(1) Tax Rate
%
1.00
(2) Taxable Income
(3) Remit monthly if taxes withheld exceed $300.00 in any three month quarter; otherwise, pay quarterly.
(If filing quarterly, use vouchers for correct period ending)
(4) Make Checks Payable to:
(5) Mail returns to:
(6) Returns Mailed After Due Dates Will be Assessed Penalties and Interest
Tear off here and remit with W-2's and 1099's
+
Tax Year __________
2016
Account # Form Type Period Ending
Annual Reconciliation of Tax Withheld Payments
38
12/31/2016
1. ________________
7. ________________
________________
Gross Wages for Year $
2. ________________
8. ________________
________________
Tax Due
3. ________________
9. ________________
________________
Tax Remitted
4. ________________
10.________________
________________
Balance Due
5. ________________
11.________________
6. ________________
12.________________
________________
Number of W-2's
Total Remitted
Remit with copies of all W-2's
And 1099 forms by January 31

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