Form Fw-3 - Employer'S Annual Reconciliation Of Income Tax Withheld - 2009
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12009
FW-3
FW-3
2009
CITY OF FLINT
EMPLOYER’S ANNUAL RECONCILIATION OF INCOME TAX WITHHELD
1. EMPLOYER
2. FEDERAL EMPLOYER IDENTIFICATION NUMBER
DUE ON OR BEFORE
3/1/2010
SUMMARY OF WITHHOLDING TAX PAID
MONTH/QUARTER
TAX WITHHELD
WITHHOLDING TAX PAID
January
February
March
FIRST QUARTER TOTAL
April
May
June
SECOND QUARTER TOTAL
July
August
September
THIRD QUARTER TOTAL
October
November
December
FOURTH QUARTER TOTAL
TOTAL WITHHOLDING TAX PAID
3.
4.
NUMBER OF W-2 FORMS ATTACHED
TOTAL TAX WITHHELD PER W-2(S)
5.
6.
BALANCE DUE
7.
OVERPAYMENT - ATTACH EXPLANATION*
TOTAL PAYROLL
8.
*SUBMIT A LETTER EXPLAINING THE OVERPAYMENT AND REQUESTING A REFUND.
11. DATE
10. NAME AND TITLE (Please Print)
9. SIGNATURE
INSTRUCTIONS FOR EMPLOYER’S ANNUAL RECONCILIATION OF INCOME TAX WITHHELD
• Check identification information in Box 1 and Box 2. If incorrect, make corrections and file Notice of Change or Discontinuance, Form F-6-IT.
• Enter tax withheld and tax payment information in the Summary of Withholding Tax Paid section.
• Enter the total withholding tax paid in Box 3.
• Enter the number of W-2 forms attached in Box 4.
• Enter the amount of tax withheld per the W-2 forms attached in Box 5. Attach an adding machine tape totaling the W-2 forms or include copies of the
computer generated summary W-2 forms.
• If the withholding tax paid (Box 3) is less than the tax withheld per the W-2 forms (Box 5), enter the balance due in Box 6. The balance due must be paid in
full with this FW-3 form. Make remittance payable to: FLINT CITY TREASURER
• If the withholding tax paid (Box 3) is greater than the tax withheld per the W-2 forms (Box 5), enter the overpayment in Box 7. To receive a refund of any
overpayment, submit a letter explaining the overpayment and requesting a refund.
• If the withholding tax paid (Box 3) equals the tax withheld per the W-2 forms (Box 5), enter a zero (0) in Boxes 6 and 7.
• Sign the return in box 9; Print your name and title in Box 10; and Enter the date signed in Box 11.
• Attach the required copies of the W-2 forms and payment for any balance due to the completed W-3 form and mail to:
CITY OF FLINT INCOME TAX DEPARTMENT, 1101 S. SAGINAW STREET, FLINT, MI 48502
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