Payroll Withholding Tax Form - City Of Auburn
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1
2EMPLOYER’S QUARTERLY RETURN OF PAYROLL TAX WITHHELD
Number of Taxable Employees _______
1. Total salaries, wages, commissions &
I hereby certify that the information and statements contained herein and
any schedule or exhibits attached are true and correct.
other compensation paid (*)
2. Less compensation paid for services
(Signed) _____________________________________________________
outside of Auburn
3. Taxable Earnings (line 1 minus line 2)
(Official Title) _______________________________ (Date) ____________
4. Actual Tax Due at 1.5%
For Period Ending
5. Penalty- 5% per month/ $25 minimum
Month
Day
Year
6. Total (include penalty if due)
March
31
20__
*If no wages were paid this quarter, mark “NONE”, sign and return form
Return Due on or Before
Month
Day
Year
Business Name:
April
30
20__
Address:
City, State Zip:
Make checks payable to: City of Auburn
Mail payment and form to: PO Box 465, Auburn, KY 42206
NOTIFY FINANCE DIRECTOR, CITY OF AUBURN, OF ANY CHANGE IN OWNERSHIP, NAME, OR
ADDRESS SHOWN ABOVE
EMPLOYER’S QUARTERLY RETURN OF PAYROLL TAX WITHHELD
Number of Taxable Employees _______
I hereby certify that the information and statements contained herein and
1. Total salaries, wages, commissions &
any schedule or exhibits attached are true and correct.
other compensation paid (*)
2. Less compensation paid for services
(Signed) _____________________________________________________
outside of Auburn
3. Taxable Earnings (line 1 minus line 2)
(Official Title) _______________________________ (Date) ____________
4. Actual Tax Due at 1.5%
For Period Ending
5. Penalty- 5% per month/ $25 minimum
Month
Day
Year
6. Total (include penalty if due)
June
30
20__
*If no wages were paid this quarter, mark “NONE”, sign and return form
Return Due on or Before
Month
Day
Year
Business Name:
July
31
20__
Address:
City, State Zip:
Make checks payable to: City of Auburn
Mail payment and form to: PO Box 465, Auburn, KY 42206
NOTIFY FINANCE DIRECTOR, CITY OF AUBURN, OF ANY CHANGE IN OWNERSHIP, NAME,
OR ADDRESS SHOWN ABOVE
EMPLOYER’S QUARTERLY RETURN OF PAYROLL TAX WITHHELD
Number of Taxable Employees _______
I hereby certify that the information and statements contained herein and
1. Total salaries, wages, commissions &
any schedule or exhibits attached are true and correct.
other compensation paid (*)
2. Less compensation paid for services
(Signed) _____________________________________________________
outside of Auburn
(Official Title) _______________________________ (Date) ____________
3. Taxable Earnings (line 1 minus line 2)
For Period Ending
4. Actual Tax Due at 1.5%
Month
Day
Year
5. Penalty- 5% per month/ $25 minimum
September
30
20__
6. Total (include penalty if due)
Return Due on or Before
*If no wages were paid this quarter, mark “NONE”, sign and return form
Month
Day
Year
October
31
20__
Business Name:
Address:
City, State Zip:
Make checks payable to: City of Auburn
NOTIFY FINANCE DIRECTOR, CITY OF AUBURN, OF ANY CHANGE IN OWNERSHIP, NAME,
Mail payment and form to: PO Box 465, Auburn, KY 42206
OR ADDRESS SHOWN ABOVE
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