Form W-3 - For Employer'S Monthly/quarterly Returns - 2016

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ITHHO
IN
TA RECONCI IATION
CITY OF FAIRFIELD
INCOME TAX DIVISION
FOR EMPLOYER’S MONTHLY/QUARTERLY
ue:
701 WESSEL DR
RETURNS – FORM W-3
FAIRFIELD, OH 45014-3611
_________________
ACCOUNT NUMBER:
PH. (513) 867-5327
_________________
EIN#:
C
PHONE NUMBER:___________________________________
See reverse side for instructions
REMITTANCES
TAXABLE WAGES
WITHHOLDING
TAXABLE WAGES
WITHHOLDING
TAXABLE WAGES
WITHHOLDING
TAXABLE WAGES
WITHHOLDING
1.
JANUARY
7.
JULY
1.
JANUARY
7.
JULY
2.
FEBRUARY
8.
AUGUST
2.
FEBRUARY
8.
AUGUST
3.
MARCH
9.
SEPTEMBER
3.
MARCH
9.
SEPTEMBER
TOTAL 1ST QTR
TOTAL 3RD QTR
TOTAL 1ST QTR
TOTAL 3RD QTR
4.
APRIL
10.
OCTOBER
4.
APRIL
10.
OCTOBER
5.
MAY
11.
NOVEMBER
5.
MAY
11.
NOVEMBER
6.
JUNE
12.
DECEMBER
6.
JUNE
12.
DECEMBER
TOTAL 2ND QTR
TOTAL 4TH QTR
TOTAL 2ND QTR
TOTAL 4TH QTR
#
13.
TOTAL NUMBER OF EMPLOYEES (W2S REQUIRED TO BE SUBMITTED ELECTRONICALLY) .......................................
$
14.
...............................................................................................................................
$
15.
16.
....................................................................................................................
$
17.
WITHHOLDING TAX LIABILITY @ 1.5% (0.015) .......................................................................................................................
$
REMITTANCES (AMOUNTS FROM REMITTANCE SECTION)
18.
1ST QTR ..................................................................................................................
$
2ND QTR .................................................................................................................
$
3RD QTR .................................................................................................................
$
4TH QTR ..................................................................................................................
$
TOTAL (ADD QUARTERS 1 THROUGH 4 FOR TOTAL REMITTANCES) ................................................................................
$
19.
IF LINE 18 GREATER THAN 17, GO TO LINE 21.
20.
BALANCE DUE (LINE 17 LESS LINE 18) .................................................................................................................................
$
Make checks payable to FAIRFIELD INCOME TAX
OVERPAYMENT - PROVIDE EXPLANATION (LINE 18 LESS LINE 17).....................................................................................
$
21.
OVERPAYMENT - PROVIDE EXPLANATION (LINE 18 LESS LINE 17.....................................................................................
$
CREDIT TO NEXT YEAR
REFUND
CREDIT TO NEXT YEAR ___________________ REFUND _____________
SIGNATURE
PRINTED NAME & TITLE
DATE
THIS SPACE FOR TAX OFFICE USE ONLY
CRE IT CAR

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