Employer'S Return Of Tax Withheld - City Of Mansfield

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CITY OF MANSFIELD – EMPLOYER’S RETURN OF TAX WITHHELD
FT
PT
FULL & PART TIME EMPLOYEES
FEDERAL IDENTIFICATION NO:__________________________________
Total wages subject to tax
$
Quarter Ending: March 31, 20
PLEASE MAIL WITH REMITTANCE TO:
City of Mansfield – Income Tax Division – P.O. Box 577 – Mansfield, Oho 44901
Tax Withheld 1.75% x line 2
$
(419) 755-9711
Adjustment from prior period
$
Please attach explanation
Late charges (4% per month + $100)
$
Total due April 30
th
$
SIGNATURE
DATE
LIST YOUR NAME ADDRESS
CITY OF MANSFIELD – EMPLOYER’S RETURN OF TAX WITHHELD
FT
PT
FULL & PART TIME EMPLOYEES
FEDERAL IDENTIFICATION NO:______________________________________
Quarter Ending: June 30, 20
Total wages subject to tax
$
PLEASE MAIL WITH REMITTANCE TO:
City of Mansfield – Income Tax Division – P.O. Box 577 – Mansfield, Oho 44901
(419) 755-9711
Tax Withheld 1.75% x line 2
$
Adjustment from prior period
$
Please attach explanation
Late charges (4% per month + $100)
$
$
Total due July 31st
SIGNATURE
DATE
LIST YOUR NAME ADDRESS
CITY OF MANSFIELD – EMPLOYER’S RETURN OF TAX WITHHELD
FT
PT
FEDERAL IDENTIFICATION NO:__________________________________
FULL & PART TIME EMPLOYEES
Quarter Ending: September 30, 20
Total wages subject to tax
$
PLEASE MAIL WITH REMITTANCE TO:
City of Mansfield – Income Tax Division – P.O. Box 577 – Mansfield, Oho 44901
(419) 755-9711
Tax Withheld 1.75% x line 2
$
Adjustment from prior period
$
Please attach explanation
Late charges (4% per month + $100)
$
Total due October 31st
$
SIGNATURE
DATE
LIST YOUR NAME ADDRESS
CITY OF MANSFIELD – EMPLOYER’S RETURN OF TAX WITHHELD
FT
PT
FULL & PART TIME EMPLOYEES
FEDERAL IDENTIFICATION NO:____________________________________
Quarter Ending: December 31, 20
Total wages subject to tax
$
PLEASE MAIL WITH REMITTANCE TO:
City of Mansfield – Income Tax Division – P.O. Box 577 – Mansfield, Oho 44901
(419) 755-9711
Tax Withheld 1.75% x line 2
$
Adjustment from prior period
$
Please attach explanation
Late charges (4% per month + $100)
$
Total due January 31st
$
SIGNATURE
DATE
LIST YOUR NAME ADDRESS

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