Form Fr-900m - Employer'S/payor'S Withholding Tax Booklet - 2012 Page 37
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472012 FR-900B Employer/Payor Withholding
Government of the
District of Columbia
*129000210000*
Tax Annual Reconciliation and Report
Important: Print in CAPITAL letters using black ink.
Taxpayer Identifi cation Number
Fill in
if FEIN
Tax Period Ending (MMYY)
FOR OFFICIAL USE ONLY
OFFICIAL USE ONLY
Fill in
if SSN
Vendor ID#0000
Fill in
if amended return
Business name
Account Number
Due Date
Business mailing address line 1
.
1. DC income tax withheld
$
this year per W-2’s/1099’s
2. Total withholding tax
.
$
paid to DC this year on
Business mailing address line 2
Forms FR-900M or FR-900Q
.
$
3. Additional Tax Due
.
(if Line 1 is more than Line 2)
.
4. Overpayment
$
City
State
Zip Code + 4
(if Line 1 is less than Line 2)
Preparer’s PTIN
2012 FR-900B P1
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