Form W-3 -For Employer'S Monthly/quarterly Returns - 2010

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2010
CITY OF FAIRFIELD
2008 WITHHOLDING TAX RECONCILIATION
DUE: 2/28/2009
DUE: 2/28/2011
INCOME TAX DIVISION
FOR EMPLOYER’S MONTHLY/QUARTERLY
701 WESSEL DR
RETURNS – FORM W-3
FAIRFIELD, OH 45014-3611
PH. (513) 867-5327
Name ______________________________________
Account Number _________________________
EIN#
PHONE NUMBER
EIN# __________________________________
Address ___________________________________
NAME
___________________________________________
ADDRESS
CITY
STATE
ZIP
City ________________ State _____ Zip _________
Phone Number __________________________
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) .......................................
$
1
£ OR EXCEPTION REQUESTED (ATTACH EXPLANATION)
1
1
14.
TOTAL PAYROLL FOR THE YEAR ............................................................................................................................................
$
15.
LESS PAYROLL NOT SUBJECT TO TAX (LIST/ATTACH EXPLANATION) ................................................................................
$
16.
PAYROLL SUBJECT TO THE TAX ............................................................................................................................................
$
17.
WITHHOLDING TAX LIABILITY @ 1.5% (0.015) .......................................................................................................................
$
REMITTANCES (AMOUNTS FROM REMITTANCE SECTION)
1ST QTR ........................................................................................................................................
$
2ND QTR .......................................................................................................................................
$
3RD QTR .......................................................................................................................................
$
4TH QTR ........................................................................................................................................
$
18.
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) .................................................................................................................................
$
21.
OVERPAYMENT - PROVIDE EXPLANATION (LINE 18 LESS LINE 17).....................................................................................
$
CREDIT TO NEXT YEAR
REFUND
SIGNATURE
PRINTED NAME & TITLE
DATE
THIS SPACE FOR TAX OFFICE USE ONLY
i
[
r
CREDIT CARD (CHECK ONE):
CARD #
EXP. DATE
NAME ON CARD
SIGNATURE
£ W2’S FILE PROCESSED

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