City Income Tax Withheld For The Tax Year - City Of Gallipolis, Ohio

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CITY OF GALLIPOLIS, OHIO — WITHHOLDING TAX RECONCILIATION
CITY INCOME TAX WITHHELD FOR THE TAX YEAR _________
DUE APRIL 30
Copies of W-2’s of taxable employees must accompany the filing of this reconciliation form.
If nonemployee compensation was paid, copies of 1099-Misc. forms must also accompany this form.
Dollars
Cents
TAX OFFICE USE ONLY
1 $
1. Total Gallipolis Payroll for the Year ..................................
TOTAL PAID $ ________________________
2 $
2. Less Payroll Not Subject to Tax (Please explain) ............
CASH
CHECK __________________
3 $
3. Payroll Subject to Tax ......................................................
RECEIPT # __________________________
4 $
4. Withholding Tax Liability @ 1% of line 3 ..........................
LATE FEE ______________ TOTAL ________________
PENALTY ______________ MONTHS LATE _________
5. Remittance
INTEREST _____________ DATE BILLED ___________
$
Month of January Due February 28 ...................................
$
Month of February Due March 31 ......................................
$
Month of March Due April 30 .............................................
$
Month of April Due May 31 ................................................
$
Month of May Due June 30 ................................................
$
Month of June Due July 31 ................................................
$
Month of July Due August 31 .............................................
$
Month of August Due September 30 ..................................
$
Month of September Due October 31 ................................
$
Month of October Due November 30 .................................
$
Month of November Due December 31 .............................
$
Month of December Due January 31 .................................
5 $
Total Remitted for the Year .............................................
6 $
6. Overpayment Credit to Next Year
(Line 4 minus Line 5) ......
7 $
7. Additional Tax Due (If Under $1.00 - Do Not Remit) ........
*Refunds are Not Issued to Active Accounts and Amounts Under $1.00.
*Late filing fee, penalty and interest will be assessed upon receipt of payment.
Account # __________ Federal ID # __________________________
Name _______________________________________________
Address _______________________________________________
City, State, Zip _______________________________________________
Submitted By _______________________________________________
Date __________ Telephone # __________________________
Use the space below for explanation of adjustments:
PLEASE RETAIN THIS COPY FOR YOUR RECORDS

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