Utah Employer's Income Withholding RECONCILIATION Return, TC-96R
WT
Submit all W-2 forms with this reconciliation.
1. Total number
Account No.
Tax
Tax Period
Due Date
of W-2's or
TC-675R's
2. Total amount
withheld this
I declare under the penalties provided by law, that to the best of my knowledge
year
and belief this is a true and correct return.
3. Total withheld
as reported
Signature
Date
to the State
Do not send money with the RECONCILIATION coupon.
Use the RECONCILIATION coupon for W-2 information
only
.
UTAH STATE TAX COMMISSION
Report any
pay additional tax on the SUPPLEMENTAL
210 NORTH 1950 WEST
ASSESSMENT coupon
, TC-96S.
SALT LAKE CITY UT 84134 - 0100
Report an overpayment and claim for refund on an
AMENDED
coupon
, TC-96A.