Reconciliation Of Income Tax Withheld Form Bw-3 - Instructions For Cd-Rom Due On Or Before February 28 For The Preceding Year Page 2

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EXHIBIT A
The City of Brook Park mandates processing withholding tax payments by Electronic Funds
MONTHLY
Transfer (EFT). Included below is a Transmission Form to register for the Tax Connect
AND
ACH-Debit payment system. This form may be used to update banking information. The
QUARTERLY
City also accepts ACH-Credit transmissions; however, attached addenda records must
utilize the approved format. The ACH-Credit registration form and the addenda record
format are available on our website. Please note a penalty will be imposed for failure to
remit taxes by Electronic Funds Transfer or for failure to adhere to the approved addenda
DECEMBER 2012
record format.
DUE 01/15/2013
JANUARY
DUE 02/15/2013
Instructions for the Tax Connect ACH-Debit payment
EXHIBIT B
FEBRUARY
DO NOT USE AS EFFECTIVE
DUE 03/15/2013
system are available on our website. Please be aware
DATES ANY SATURDAY, SUNDAY OR
when selecting effective dates, avoid those shown
FEDERAL OBSERVED HOLIDAYS
MARCH
01/01/2013
09/02/2013
in Exhibit B. The effective date must be
DUE 04/15/2013
01/21/2013
10/14/2013
2 business days in advance and less than
02/18/2013
11/11/2013
APRIL
05/27/2013
11/28/2013
DUE 05/15/2013
30 days in the future.
07/04/2013
12/25/2013
MAY
DUE 06/15/2013
th
See Exhibit A for due dates. As shown, trust funds are due on or before the 15
day
JUNE
DUE 07/15/2013
following the close of the month. Employers who have petitioned and are approved for
quarterly payments should remit on or before the last day of the month following the end of
JULY
DUE 08/15/2013
the calendar quarters (See Note A). Accounts not in compliance will be subject to
assessments. The current rate is 11 ½% per month or fraction thereof. Courtesy withholders
AUGUST
DUE 09/15/2013
please contact the Department of Taxation for remittance forms.
SEPTEMBER
DUE 10/15/2013
(Note A) Employers remitting less than $100.00 per month may petition the Tax Director to
OCTOBER
DUE 11/15/2013
remit on a quarterly basis. Refer to Ordinance 1713.02 (d) on our website
. Call (216) 433-1533 or fax your request to (216) 433-0822 for
NOVEMBER
DUE 12/15/2013
exemption.
DECEMBER 2013
DUE 01/15/2014
Complete the form below if you are a new employer and need to register or you are an
existing company which needs to update banking information
TRANSMISSION FORM
PLEASE PRINT LEGIBLY
ATTACH VOIDED CHECK
CITY OF BROOK PARK TAX ACCOUNT NUMBER__________________________
APPROVED
QUARTERLY
1.) Company Name: __________________________________________________
FID #: __________________________________________________________
JAN - MARCH
04/30/2013
Address: _________________________________________________________
APRIL - JUNE
07/31/2013
2.) Financial Institution Name: ___________________________________________
JULY - SEPT
10/31/2013
3.) Financial Institution’s ABA/Routing Number: _____________________________
OCT – DEC 2013
01/31/2014
4.) Financial Institution’s Account Number: _________________________________
Contact Person: ___________________________________________________
(Please Print Name)
Phone Number: ______________________Fax Number: _____________________
Signature:______________________________________Date:__________________
Information provided on this form is confidential and used for City Income Tax purposes only. NOTE:
Failure to remit by electronic funds transfer or for electronic transactions returned due to incorrect
banking information will subject taxpayer to penalty assessment.
*To begin ACH-Debit payments fax the Transmission Form along with voided check (216) 433-0822*

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