WITHHOLDING TAX RETURN
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
MONTHLY
DIVISION OF TAXATION - DEPT#200 - PO BOX 9703 - PROVIDENCE, RI 02940-9703
TEMPORARY
Use in lieu of preprinted coupon booklet
WTM
NAME
ADDRESS
FEDERAL
IDENTIFICATION
NUMBER
CITY, STATE, ZIP CODE
RETURN FOR
MONTH ENDING
TAX AMOUNT
I HEREBY CERTIFY THAT THIS RETURN TO THE BEST OF MY KNOWLEDGE AND
,
,
.
DUE AND PAID
BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN.
SIGNATURE OF OWNER, PARTNER OR AUTHORIZED AGENT
TITLE
DATE
WITHHOLDING TAX RETURN
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
MONTHLY
DIVISION OF TAXATION - DEPT#200 - PO BOX 9703 - PROVIDENCE, RI 02940-9703
TEMPORARY
Use in lieu of preprinted coupon booklet
WTM
NAME
ADDRESS
FEDERAL
IDENTIFICATION
NUMBER
CITY, STATE, ZIP CODE
RETURN FOR
MONTH ENDING
TAX AMOUNT
I HEREBY CERTIFY THAT THIS RETURN TO THE BEST OF MY KNOWLEDGE AND
,
,
.
DUE AND PAID
BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN.
TITLE
SIGNATURE OF OWNER, PARTNER OR AUTHORIZED AGENT
DATE
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF REVENUE
DIVISION OF TAXATION
INSTRUCTIONS FOR PREPARING MONTHLY RETURN
DUE ON OR BEFORE THE 20
OF EACH MONTH FOR THE PREVIOUS CALENDAR MONTH,
TH
EXCEPT FOR THE MONTHS OF MARCH, JUNE, SEPTEMBER AND DECEMBER WHICH ARE DUE ON OR BEFORE THE LAST DAY OF THE FOLLOWING MONTH
GENERAL INSTRUCTIONS
WHO MUST USE THIS FORM
a. Enter the employer’s name and address in the appropriate sections above.
This form must be used by employers who withhold $50.00 or more, but less than
$600.00 for a calendar month from employees’ wages.
b. Enter the employer’s Federal Identification Number in the section marked “FEDERAL
IDENTIFICATION NUMBER”.
Consecutive returns for each calendar month accounting for all taxes withheld during
the year must be filed by an employer required to report monthly. If no tax was withheld
c. Enter the month and year covered by this return in the section marked “RETURN
during a particular month, a return is still required to be filed for such month. In this
FOR MONTH ENDING”. Returns and remittances should be for all income taxes with-
case, enter $0 in the “TAX AMOUNT DUE AND PAID” box.
held from wages paid during the month.
If the amount withheld reaches or exceeds $600.00 for any calendar month, the employ-
d. Enter the amount withheld and remitted in the section marked “TAX AMOUNT DUE
er must begin to the file quarter/monthly or daily as required.
AND PAID”.
An annual reconciliation of tax withheld must be filed by the employer with the Division
e. The return must be signed. The person signing must also identify themselves as
of Taxation on or before February 28th.
“owner”, “partner”, or in the case of a corporation, “treasurer” etc.
Electronic Funds Transfer (EFT) is mandated for some taxpayers. Both ACH credit and ACH debit methods are available. For information or authorization
on Electronic Funds Transfer, please call (401) 574-8732 or (401) 574-8901 . You can also visit for more information.