Form W-3 - Employee Listing And Reconciliation Of Tax Withheld For The Year - Village Of Bolivar

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Form W-3
File on or before J.nu.ry
31,
VILLAGE OF BOLIVAR
-
INCOME
TAX
DEPARTMENT
P. O. Box 204 - Bolivar, Ohio 44612
EMPLOYER'S NAME.
ADDRESS & ACCOUNT NUMBER
TAXES W1TIIJIELD AND
REMITTANCES MADE
Quarters Wlthhelcl
Amoant
Wl•••••• lcl
EMPLOYEE LISTING AND RECONCILIATION
OF TAX
WITHHELD'
FOR THE YEAR
NUMBER OF PAGES TO THIS
REPORT
NUMBER OF EMPLOYEES
REPORTED
Use this form for reporting
the names,
address,
gross earnings
and Bolivar Village
Income
Tax
withheld from employees during
this year.
If
commercially reproduced W·2
Forms
are submitted
In lieu of
IIsdng,
use
this fonn as a reconciliation and control
sheet.
If more space for
listing Is required, continue on back of
page, or attach additional
sheets.
latQUARTER
2nd QUARTER
-
3rd QUARTER
-
4th QUARTER
-
-
-
-
ADJUSTMENTS
(Explain)
EllPLO'RE USTIXO
GROSS
EARNINGS
CITY
TAX
WITHHELD
Nam.
cmd
Addr••• of Employ••
BOLIVAR
OTHER
TOTAL THIS PAGE
..
TOTAL ALL PAGES
TOTAL AMOUNT
WITHHELD
-
$
TOTAL REMITTANCES
MADE -
DIFFERENCE
(If
any)
-
-
$
TAX
DEPARTMENT
COPY

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