Form Grw-3 - Employer'S Annual Reconciliation Of Income Tax Withheld - 2012
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12012 GRW-3
CITY OF GRAND RAPIDS
GRW-3 2012
EMPLOYER'S ANNUAL RECONCILIATION OF INCOME TAX WITHHELD
1. EMPLOYER
2. FEDERAL EMPLOYER IDENTIFICATION NUMBER
DUE ON OR BEFORE
02/28/2013
SUMMARY OF WITHHOLDING TAX PAID
WITHHOLDING TAX
MONTH/QUARTER
TAX WITHHELD
PAID
January
February
March
FIRST QUARTER TOTAL
April
May
June
SECOND QUARTER TOTAL
July
August
September
THIRD QUARTER TOTAL
October
November
December
FOURTH QUARTER TOTAL
3.
TOTAL WITHHOLDING TAX
PAID
NUMBER OF W-2 FORMS ATTACHED
4.
TOTAL TAX WITHHELD PER W-2(S)
5.
BALANCE DUE
6.
OVERPAYMENT – ATTACH EXPLANATION *
7.
* Submit a letter to request a refund. Include a detailed explanation on the cause of the overpayment.
8. SIGNATURE
9. NAME AND TITLE (PLEASE PRINT)
10. DATE
11. PHONE NUMBER
INSTRUCTIONS FOR EMPLOYER'S ANNUAL RECONCILIATION OF INCOME TAX WITHHELD
Check identification information in Box 1 and Box 2. If incorrect, make corrections and file Notice of Change or Discontinuance,
Form GR-6-IT.
Enter tax withheld and tax payment information in the Summary of Withholding Tax Paid section.
Enter the total withholding tax paid in Box 3.
Enter the number of W-2 forms attached in Box 4.
Enter the amount of tax withheld per the W-2 forms attached in Box 5. ATTACH W-2 FORMS and an adding machine tape
totaling the Grand Rapids tax withheld on the W-2 forms or include copies of the summary W-2 forms.
If the withholding tax paid (Box 3) is less than the tax withheld per the W-2 forms (Box 5), enter the balance due in Box 6. The
balance due must be paid in full with this GRW-3 form. Make remittance payable to: Grand Rapids CITY TREASURER
If the withholding tax paid (Box 3) is greater than the tax withheld per the W-2 forms (Box 5), enter the overpayment in Box 7. To
receive a refund of any overpayment, submit a letter explaining the overpayment and requesting a refund.
If the withholding tax paid (Box 3) equals the tax withheld per the W-2 forms (Box 5), enter a zero (0) in Boxes 6 and 7.
Sign return in Box 8; print your name and title in Box 9; enter date signed in Box 10; and enter your phone number in Box 11
Attach the required copies of the W-2 forms and payment for any balance due to the completed GRW-3 form and mail to: GRAND
RAPIDS INCOME TAX DEPARTMENT, PO BOX 347, GRAND RAPIDS, MI 49501-0347.
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