Employer Withholding Tax Reconcilation

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Village of Westfield Center
EMPLOYER WITHHOLDING TAX RECONCILATION
Income Tax Department
Due on or Before last day of February following tax year
P. O. Box 750
FOR TAX YEAR: ____________
Parts 2 and 4 should be identical, explain fully any
1. Total number of employees as
discrepancy.
represented on forms W-2 submitted
herewith: __________
3. Total income tax withheld from compensation during:
2. Total income tax withheld from
1
Quarter ending March 31:
$____________
st
Compensation paid all employees:
2
Quarter ending June 30:
$____________
nd
$____________
3
rd
Quarter ending Sept. 30:
$____________
Account Number #________________
4
th
Quarter ending Dec. 31:
$____________
4. Total amount Withheld:
Fed. ID #_________________
$____________
0.00
Company Name & Address:
_______________________________________
I hereby certify that the information and statements
contained herein are true and correct.
_______________________________________
__________________________________________________
Signature
____________________________________
_____________________________________________
Official Title
(Date)

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