Newark Payroll Tax Statement Form - 2013 Page 3
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Quarter 2013 FORM
DELINQUENT AFTER October 31, 2013
NEWARK PAYROLL TAX STATEMENT
USE BLACK INK AND STAY INSIDE THE LINE
BUSINESS TAX ID NUMBER
BUSINESS START DATE
BUSINESS NAME
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
EMAIL ADDRESS
NO. OF EMPLOYEES
BUSINESS CLOSED ___________
SOLD DATE ____________
For Third Quarter ended September 30, 2013 (payment due October 31, 2013)
Total wages, tips and other compensation
1.
If payroll does not exceed 2,500.00 in any calendar quarter please attach
.
supporting documentation (941, Schedule C, Payroll Register, Etc.)
2.
Apportionment (If Applicable)
(See the apportionment section of the instructions)
a.
______________
b.
______________
c.
______________
d.
______________
Total Apportionment
.
Total Taxable Payroll (enter line 1 if no apportionment; otherwise, subtract
3.
.
apportionment- line 2, from line 1 and enter the remainder on line 3)
4.
Payroll Tax Calculated (Multiply line 3 by Payroll Tax rate of 1% or (.01)
.
If paid after October 31, 2013, enter INTEREST (see instruction)
5.
.
6.
If paid after October 31, 2013, enter PENALTY (see instruction)
.
TOTAL DUE. (Add Lines 4, 5, & 6)
7.
Make check payable to: City of Newark-Payroll Tax
.
Under the laws of the State of New Jersey, I declare under penalty of perjury that I have read the foregoing and that it is true, correct, and complete to best of my
knowledge and belief
X
SIGN HERE
DATE
THIS STATEMENT MUST BE FILED BY October 31, 2013 OR YOU WILL BE SUBJECT TO INTEREST AND PENALTIES
3/2013
PLEASE DO NOT TEAR APART HERE
CITY OF NEWARK- PAYROLL TAX
P.O. BOX 15118
NEWARK, NEW JERSEY 07192
PAYROLL TAX
TAXPAYER ASSISSTANCE: PHONE: (973) 733-3770 IN –PERSON: 920 BROAD STREET RM B-26
STATEMENT
BUSINESS TAX ID NUMBER
CONTACT NAME
PAYMENT ENCLOSED
NOTE: Payment enclosed must equal the amount due on Line 7
(
)
Please write your Business Tax ID on your check
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