Form W-3 - Reconciliation Of Amherst Income Tax Withheld From Wages
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1CITY OF AMHERST, OHIO
Form W-3
Year _____________
RECONCILIATION OF AMHERST INCOME TAX WITHHELD FROM WAGES
1. Total number of employees as shown by attached
2.
$ ________________
Wages earned for work performed in Amherst
$ ________________
Tax withheld at 1.5%
wage statements
__________
$ ________________
Wages withheld on for residents of Amherst
Federal ID #: _________________________
$ ________________
Tax withheld at 1.5%
$ ________________
Tax withheld at .5%
Company Name and Address:
3.
$ ________________
Total tax withheld per W-2's attached
_______________________________
_______________________________
You may notify our office of zero withholding by emailing us at
_______________________________
. Please use the subject line "zero
withholding" and include the company name, FID number, and
_______________________________
month or quarter you are reporting.
______________________________________
4.
AMHERST - WITHHOLDING TAX PAID DURING YEAR ON FORM W-1
JANUARY
$ ________________
FEBRUARY
$ ________________
This reconciliation must be filed with the Amherst Income
MARCH
$ ________________
Tax Department on or before the last day of February
$ ________________
(OR) QUARTER ENDED MARCH 31
A written request for an extension may be requested.
APRIL
$ ________________
MAY
$ ________________
JUNE
$ ________________
This form must be accompanied by copies of the
employer's statements (Form W-2) or a printout
$ ________________
(OR) QUARTER ENDED JUNE 30
showing the following information:
JULY
$ ________________
1. Name and address of employee
AUGUST
$ ________________
2. Social Security number
SEPTEMBER
$ ________________
$ ________________
3. Total Qualifying Wages and Local Wages
(OR) QUARTER ENDED SEPTEMBER 30
OCTOBER
$ ________________
4. Amount of Amherst income tax withheld
NOVEMBER
$ ________________
5. Name, address and Federal ID number of
DECEMBER
$ ________________
employer.
$ ________________
(OR) QUARTER ENDED DECEMBER 31
File with:
5. TOTAL REMITTED FOR YEAR
$
CITY OF AMHERST INCOME TAX DEPARTMENT
480 PARK AVENUE
6. A) ADDITIONAL TAX DUE
$ ________________
AMHERST, OH 44001
If the difference between Lines 3 and 5 indicates a balance due
that amount must accompany this return.
PHONE (440) 988-4212
FAX (440) 988-3749
email address:
website:
B) OVERPAYMENT
$ ________________
PLEASE INDICATE:
REFUND _____
CREDIT TO NEXT YEAR _____
If the difference indicates an overpayment, attach an explanation
(Amounts of $10.00 or less will not be refunded)
Signature: ______________________________________
Date: _____________
Phone: _________________________
Email Address: _________________________________________________
Reconciled
_____
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