Return Of Income Tax Withheld Form

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PHONE 330-854-9448
CITY OF CANAL FULTON
RETURN OF INCOME TAX WITHHELD
Make check or money order payable to: CITY OF CANAL FULTON
If you did not have any employees this period,
please so state and return this form
TOTAL SALARIES, WAGES, ETC.
File
CANAL FULTON INCOME TAX DEPARTMENT
with:
155 E. MARKET ST. SUITE #C
CANAL FULTON, OHIO 44614-0516
SUBJECT TO
1.
$
CANAL FULTON TAX
CITY OF CANAL FULTON
RETURN OF
TOTAL TAX WITH-
ACCOUNT NUMBER
DUE ON OR BEFORE
TAX RATE
2.
$
INCOME TAX WITHHELD
HELD THIS PERIOD
ACCOUNT NUMBER
ADJUSTMENTS TO
FROM
TO
3.
$
PRIOR RETURNS
FOR
PERIOD
PENALTY
DUE ON OR BEFORE
4.
$
5% PER MONTH
($50.00 MIN)
INTEREST
5.
$
1. SUBJECT TO CANAL FULTON TAX
1% PER MONTH
TO:
AMOUNT PAID
6.
2. TOTAL TAX WITHHELD THIS PERIOD
HEREWITH
AVOID PENALTY - FILE AND PAY PROMPTLY
3. ADJUSTMENTS TO PRIOR RETURNS
4. PENALTY 5% PER MONTH ($50.00 MIN.)
I HEREBY CERTIFY THAT THE INFORMATION AND STATEMENTS
CONTAINED HEREIN ARE TRUE AND CORRECT.
5. INTEREST 1% PER MONTH
NOTIFY OFFICE OF ANY CHANGE IN NAME OR ADDRESS
________________________________________________________
6. AMOUNT PAID HEREWITH
SIGNATURE
DATE

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