Form Fr-900b - Employer/payor Withholding Tax - Annual Reconciliation And Report - 2012
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2This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
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2012
FR-900B Employer/Payor Withholding
*129000210002*
Government of the
District of Columbia
Tax - Annual Reconciliation and Report
Clear
Taxpayer Identification Number
Fill in
if FEIN
Tax Period Ending (MMYY)
OFFICIAL USE ONLY
FOR OFFICIAL USE ONLY
Fill in
if SSN
Vendor ID#0002
Fill in
if Amended return
Business name
Account Number
Due Date
DOLLARS ONLY
Business mailing address line 1
.
1. DC income tax withheld
$
this year per W-2’s/1099’s
2. Total withholding tax
.
$
paid to DC this year on
Business mailing address line 2
Forms FR-900M or FR-900Q
.
$
.
3. Additional Tax Due
(if Line 1 is more than Line 2)
.
$
4. Overpayment
City
State
Zip Code + 4
(if Line 1 is less than Line 2)
Preparer’s PTIN
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2012 FR-900B P1
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