Form W-1 - Monthly/quarterly Withholding Form

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Account Number#____________
FEIN #
Name & Address: ______________________________________
______________________________________
______________________________________
Phone Number
Contact Person
MONTHLY/QUARTERLY WITHHOLDING FORM
________ Tax Year
TAXES WITHHELD FOR THE PERIOD CHECKED:
Month of January – Due 2/28
Month of July – Due 8/31
Month of February – Due 3/31
Month of August – Due 9/30
Month of March – Due 4/30
Month of September – Due 10/31
st
rd
1
Quarter (Jan thru March) – Due 4/30
3
Quarter (July thru Sept) – Due 10/31
Month of April – Due 5/31
Month of October – Due 11/30
Month of May – Due 6/30
Month of November – Due 12/30
Month of June – Due 7/31
Month of December – Due 1/31
nd
th
2
Quarter (April thru June) –Due 7/31
4
Quarter (Oct thru Dec) – Due 1/31
1. Number of Taxable Employees
2. Total Payroll Subject to Withholding
$
3. Withholding tax liability (1 ½ % of Line 2)
$
4. Additional/Courtesy Residency Tax Withheld
$
5. Total Amount Paid (Line 3 plus line 4)
$
:
Make Remittance Payable to
CITY OF DOVER
_
Signature
Date
W-1 Form
PLEASE COPY FORM AS NEEDED

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