Form Xw-1 - Return Of Income Tax Witheld - State Of Ohio

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City of Xenia Income Tax
Form XW-1 Rev. 6/2000
File with:
DIVISION OF TAXATION
RETURN OF INCOME TAX WITHHELD
P O BOX 490
Present Tax Rate is 1.75%
XENIA OH 45385-0490
IF YOU DID NOT HAVE ANY EMPLOYEES THIS PERIOD,
1. Federal ID No.
I
PLEASE SO STATE AND RETURN THIS FORM.
2. Filing period (Month or Qtr. End)
/2000
Due:
CHECK HERE IF YOU WANT THIS ACCOUNT INACTIVATED ‘
3. Total wages paid during period . . . . . . . . .
I declare that this return is a true, complete and correct return, pursuant to
the Xenia City Income Tax Ordinance and Regulations.
4. Total tax @ 1.75% . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. a. Penalty $
Signed
By
b. Interest $
Business name
Date
c. Total 5a & 5b . . . . . . . . . . . . . . . . . . . . . . . .
6. Adjustment to prior returns . . . . . . . . . . . . . . . . . . . . . . .
AMOUNT RECEIVED
Make remittance payable to the City of Xenia
7. Total payable for period . . . . . . . . . . . . . . . . . . . . . . . . .
Phone (937) 376-7248
AUDITED BY
DATE

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