Income Tax Withheld Form

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FILING FREQUENCY
DUE ON OR BEFORE
FOR TAX PERIOD ENDING
MUNICIPAL INCOME TAX DIVISION
RETURN OF INCOME TAX WITHHELD FOR:
FED. IDENTIFICATION NO.
CODE
ACCOUNT NO.
DO NOT WRITE IN THIS SPACE
MUNICIPALITY OF:
TAX RATE:
FILE TAX RETURNS AND PAY TAXES PROMPTLY TO AVOID PENALTIES
THIS C ARD M UST BE RE TURNED W ITH YOUR REM ITTANCE
I DECLAIR THAT THIS RETURN HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN, MADE IN GOOD
FAITH PURSUANT TO THIS MUNICIPALITY’S INCOME TAX ORDINANCE AND REGULATIONS
1.
TOTAL WAGES,
SALARIES, ET C.
TAXABLE TO:
$
SIGNATURE & TITLE
DATE
2.
TOTAL TAX WITHHELD DURING PERIOD
$
NOTIFY DIVISION OF TAXATION PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS
3.
ADJUSTMENTS TO PRIOR RETURNS
$
MAIL TO:
CITY OF HAMILTON
4.
PENALTY
$
MAKE REMITTANCE
DIVISION OF TAXATION
PAYABLE TO:
5.
INTEREST
$
PO BOX 630314
CITY OF HAMILTON
6.
TOTAL AMOUNT REMITTED HEREWITH
$
CINCINNATI, OH 45263-0314
PHONE 1-800-854-1684
LOCAL (513) 868-5838
IF YOU DO NOT HAVE ANY EMPLOYEES THIS PERIOD, PLEASE SO STATE AND RETURN THE ORIGINAL COPY OF THIS FORM.
FILING FREQUENCY
DUE ON OR BEFORE
FOR TAX PERIOD ENDING
MUNICIPAL INCOME TAX DIVISION
RETURN OF INCOME TAX WITHHELD FOR:
FED. IDENTIFICATION NO.
CODE
ACCOUNT NO.
DO NOT WRITE IN THIS SPACE
MUNICIPALITY OF:
TAX RATE:
FILE TAX RETURNS AND PAY TAXES PROMPTLY TO AVOID PENALTIES
THIS C ARD M UST BE RE TURNED W ITH YOUR REM ITTANCE
I DECLAIR THAT THIS RETURN HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN, MADE IN GOOD
FAITH PURSUANT TO THIS MUNICIPALITY’S INCOME TAX ORDINANCE AND REGULATIONS
1.
TOTAL WAGES,
SALARIES, ET C.
TAXABLE TO:
$
SIGNATURE & TITLE
DATE
2.
TOTAL TAX WITHHELD DURING PERIOD
$
NOTIFY DIVISION OF TAXATION PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS
3.
ADJUSTMENTS TO PRIOR RETURNS
$
MAIL TO:
CITY OF HAMILTON
4.
PENALTY
$
MAKE REMITTANCE
DIVISION OF TAXATION
PAYABLE TO:
5.
INTEREST
$
PO BOX 630314
CITY OF HAMILTON
6.
TOTAL AMOUNT REMITTED HEREWITH
$
CINCINNATI, OH 45263-0314
PHONE 1-800-854-1684
LOCAL (513) 868-5838
IF YOU DO NOT HAVE ANY EMPLOYEES THIS PERIOD, PLEASE SO STATE AND RETURN THE ORIGINAL COPY OF THIS FORM.
FILING FREQUENCY
DUE ON OR BEFORE
FOR TAX PERIOD ENDING
MUNICIPAL INCOME TAX DIVISION
RETURN OF INCOME TAX WITHHELD FOR:
FED. IDENTIFICATION NO.
CODE
ACCOUNT NO.
DO NOT WRITE IN THIS SPACE
MUNICIPALITY OF:
TAX RATE:
FILE TAX RETURNS AND PAY TAXES PROMPTLY TO AVOID PENALTIES
THIS C ARD M UST BE RE TURNED W ITH YOUR REM ITTANCE
I DECLAIR THAT THIS RETURN HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN, MADE IN GOOD
FAITH PURSUANT TO THIS MUNICIPALITY’S INCOME TAX ORDINANCE AND REGULATIONS
1.
TOTAL WAGES,
SALARIES, ET C.
TAXABLE TO:
$
SIGNATURE & TITLE
DATE
2.
TOTAL TAX WITHHELD DURING PERIOD
$
NOTIFY DIVISION OF TAXATION PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS
3.
ADJUSTMENTS TO PRIOR RETURNS
$
MAIL TO:
CITY OF HAMILTON
4.
PENALTY
$
MAKE REMITTANCE
DIVISION OF TAXATION
PAYABLE TO:
5.
INTEREST
$
PO BOX 630314
CITY OF HAMILTON
6.
TOTAL AMOUNT REMITTED HEREWITH
$
CINCINNATI, OH 45263-0314
PHONE 1-800-854-1684
LOCAL (513) 868-5838
IF YOU DO NOT HAVE ANY EMPLOYEES THIS PERIOD, PLEASE SO STATE AND RETURN THE ORIGINAL COPY OF THIS FORM.

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