Form W-3 - Mantua Village Tax Reconciliation - 2015
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1FORM W-3 ~ MANTUA VILLAGE TAX RECONCILIATION ~ 2015
Employer's Name, address, and FEIN number
File with:
Village of Mantua
Income Tax Dept.
P.O. Box 775
Mantua, Ohio 44255
INSTRUCTIONS
If item 7 indicates overpayment and refund is desired, attach explanation. If additional tax due is indicated, enclose
payment when filing.
The tax ordinance requires the annual preparation and filing of this report, from all employers subject to the tax, on
or before the end of January, 2016.
Other information required to be submitted with this report is the name and address of each employee completely,
or only in part, subject to tax during the tax year, the total gross earnings of each such employee and the amount of
tax withheld from those earnings. If additional space is required, continue on reverse side, or attach additional
sheets. Employers desiring to submit commercially reproduced copies of federal W-2 or electronic reproductions
bearing the required information in either card or listing form may do so in lieu of the listing form.
1.
Total Number of Employees
_____________________
TOTAL MANTUA INCOME TAX
WITHHELD AND REMITTED
2.
Total Payroll of the Year
3.
Less Payroll Not Subject to Tax
$ ____________________
First Quarter (3/31)
$ ____________________
4.
Payroll Subject to Tax
Second Quarter (6/30)
$ ____________________
5.
Withholding Tax Liability,
Third Quarter (9/30)
$ ____________________
1 1/2% of Line 4
$ ____________________
Fourth Quarter (12/31)
$ ____________________
$ ____________________
6. Total Remitted for Year
$ ____________________
$ ____________________
7. Overpayment OR
$ ____________________
8. Additional Tax Due
$ ____________________
LIST OF EMPLOYEES
AMOUNT OF TOTAL
AMOUNT OF VILLAGE
Names and Addresses
GROSS EARNINGS
TAX WITHHELD
.
.
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