Form Fr-900b - Employer/payor Withholding Tax Annual Reconciliation And Report - 2016
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2016 FR-900B Employer/Payor Withholding
*169000210002*
Government of the
Tax Annual Reconciliation and Report
District of Columbia
This is a FILL-IN format. Please do not handwrite
any data on this form other than your signature.
Taxpayer Identification Number
Account Number
Tax Period Ending
Fill in
if FEIN
(MMYY)
Vendor ID# 0002
Fill in
if SSN
Business name
Due Date
Fill in if:
(MMDDYY)
amended return
Business mailing address line 1
Business mailing address line 2
City
State
Zip code +4
WAGE (W-2) INFORMATION
NON-WAGE (W1099) INFORMATION
.
.
1. DC income tax withheld
$
$
this year
2. Total withholding tax
.
.
$
$
paid to DC this year on
Forms FR-900M or FR-900Q
TOTAL
.
.
.
$
$
$
3. Additional Tax Due
(if Line 1 is more than Line 2)
.
.
.
$
$
$
4. Overpayment
(if Line 1 is less than Line 2)
Employer’s DC Withholding Tax Reconciliation
Month
DC Taxes Withheld
DC Taxes Withheld on
Total DC Taxes
Explanation
on Wages (W-2)
Non-wage Payments (1099)
Withheld
$
$
$
1
$
$
$
2
$
$
$
3
$
$
$
1st Qtr
$
$
$
4
$
$
$
5
$
$
$
6
$
$
$
2nd Qtr
$
$
$
7
$
$
$
8
$
$
$
9
$
$
$
3rd Qtr
$
$
$
10
$
$
$
11
$
$
$
12
$
$
$
4th Qtr
$
TOTAL WAGES
W-2s
from
TOTAL DC TAXES WITHHELD
$
$
TOTAL NON-WAGE PAYMENTS
1099s
from
COMBINE W-2 and 1099 AMOUNTS
Taxpayer’s Signature
Title
Date (MMDDYYYY)
Contact Telephone Number
Paid Preparer’s Signature
Date (MMDDYYYY)
Preparer’s Identification Number (PTIN)
Firm Name_______________________________________________________Address_______________________________________________________________________________________________________
Under penalties of perjury, I declare that the designated agent has authorized me to sign on behalf of all members of the combined group, and that I have examined this form and the information contained
herein is, to the best of my knowledge and belief, correct and complete.
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Make check or money order payable to the DC Treasurer. Include your FEIN or SSN, “FR-900B” and the tax year on your payment. This return is due January 31, 2017 or within thirty (30) days of your
final payroll. Mail this return with payment separately from your monthly or quarterly return to: DC Office of Tax and Revenue, PO Box 96385 Washington, DC 20090-6385.
Rev. 01/2017
2016 FR-900B P1
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