Village of Spencerville Income Tax
Form SW-1
ORIGINAL
EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
Instructions on Reverse
PLEASE DO NOT STAPLE
Side of Taxpayer’s Copy
CHECKS TO FORM
I hereby certify that the information and statements contained herein
1. Total Spencerville Wages During Quarter
$
are true and correct.
2. Total Tax Withheld During Quarter
(Signed)
(1
1
/
% of line 1.)
4
3. Adjustments to Prior Returns
(Title)
Date
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4. Interest
THIS RETURN MUST BE FILED
5. Penalty (See Instructions)
ON OR BEFORE THE DUE DATE AS SHOWN BELOW
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MAKE CHECK OR MONEY ORDER PAYABLE TO:
6. Total Payable Herewith
$
$
VILLAGE OF SPENCERVILLE INCOME TAX
If no wages paid this quarter, mark “None” and return form.
FOR QUARTER ENDING
Mail to:
*
*
Village of Spencerville
DUE ON OR BEFORE
Income Tax Department
P.O. Box 57
Spencerville, Ohio 45887
419-647-4171
*
*
If name or address in incorrect, make necessary change.
WHO MUST FILE:
The failure of any taxpayer to receive or procure a return shall not excuse such
taxpayer from making a return or paying the tax.
Each employer within or doing business within the Village of Spencerville,
Ohio, who employs one or more persons (full time or part time) is required to
HOW TO PREPARE THIS FORM:
withhold the tax of 1
1
/
percent from all gross salaries, wages, commissions,
4
incentive payments, director fees, bonuses and other compensation paid
Line 1 – Total Spencerville wages during the quarter.
taxable employees at the time such compensation is paid, using the
Line 2 – Enter total actual tax withheld from employees during the quarter for
Medicare tax wage base, and to file Form SW-1 and remit tax to the Village
Spencerville Income Tax.
Income Tax Department on or before the last day of the month next following
Line 3 – To adjust current payment of actual tax withheld for underpayment or
the quarterly period in which the withholding deduction was made.
overpayment in previous quarter.
Line 4 – If return is past due, enter
/
of 1% of the amount of Line 2 for each month,
1
FAILURE TO FILE RETURN AND PAY TAX:
2
or part of month, past due.
Any taxpayer who shall fail or refuse to make any return or declaration
required by the Ordinance, or any taxpayer who shall refuse to pay the tax,
Line 5 – If return is past due, enter 5% of the amount of Line 2 per month or fraction
penalties and interest imposed by the Ordinance or any taxpayer who shall
thereof.
refuse to permit the Village Tax Administrator or any duly authorized agent or
Line 6 – Total of Lines 2, 3, 4, 5.
employee to examine his books, records and papers, or who shall knowingly
make any incomplete, false or fraudulent return, or who shall attempt to avoid
Any payments of tax received, or in case of payment by mail are postmarked after
the payment of tax, shall be guilty of a misdemeanor and shall be fined not
the due date, are subject to the interest and penalty.
more than $500 or imprisoned for not more than six (6) months, or both.