EMPLOYER S MUNICIPAL INCOME TAX WITHHOLDING FORMS

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CITY TAX DEPT 50 TOWN SQUARE P.O. BOX 155 LIMA, OHIO 45802 PHONE (419) 221-5245 FAX (419) 998-5527 FORM LW-1 (MONTHLY OR QUARTERLY STATEMENT) FORM LW-3 (ANNUAL RECONCILIATION) EMPLOYER S MUNICIPAL INCOME TAX WITHHOLDING FORMS

INSTRUCTIONS FOR FILING FORM LW-1 WHO MUST FILE Each employer within the City of Lima who employs one or more employees on a salary, wage, commission or other compensation basis, shall deduct from such compensation earned and paid on and after Jan. 1, 1983 the tax of 1.5% of salaries, wages, commission and other compensation due by the employer to the employee, and shall make this return of Form LW-1, the Director of Taxation, and pay to the City of Lima the amount of taxes so deducted on or before the day shown on the front of this return. DEFINITION OF EMPLOYER The term employer means an individual, partnership, association, corporation, governmental body unit or agency, or any other entity whether or not organized for profit, who or that employes one of more persons on a salary, wages, commission or other compensation basis. Employer must also submit W-2 forms that include qualifying wages and tax withheld for all other municipal corporations. Lima Tax Department 419-221-5245. INTEREST All taxes unpaid after they have become due bear interest from the date due. The interest rate is based on the Federal rate and may change annually. Visit our website at www.cityhall.lima.oh.us for interest rates. PENALTIES Any taxpayer or employer who shall fail to file a return within the time required by the Ordinance, in addition to the interest and other penalty hereby imposed, shall be liable for a late file penalty of $25 per month or fraction of a month thereof (maximum $150) and a late payment penalty of up to 50% of the unpaid withholding tax due. Also an employer who fails to deduct, withhold, and/or remit the tax of an employee, or who shall attempt to do anything whatever to avoid the payment of the whole or any part of the tax shall be guilty of a first degree misdemeanor and shall be fined not more than one thousand dollars ($1000) or imprisoned for not more than 6 months or both. The failure of any employer to receive or procure a return form shall not excuse him from making a return or from paying the tax. Payment of the penalty provided in this section shall not be construed as relieving a taxpayer of liability for the tax, interest and/or other penalty assessed.

EMPLOYERS RETURN OF TAX WITHHELD CITY OF LIMA, OHIO DEPT. OF TAXATION FORM LW-1 1. GROSS WAGES SUBJECT TO WITHHOLDING... $ 2. ACTUAL TAX WITHHELD THIS PERIOD... $ If payment is past due, complete below (See instructions) 3. LATE FEE (See instructions)... $ 4. INTEREST (See instructions)... $ 5. PENALTY (See instructions)... $ 6. TOTAL... $ If no wages paid this period mark None and return form with explanation. I HEREBY CERTIFY that the information and statements contained herein and any schedules attached are true and correct. (Signed) (Official Title) Date OWNER, PARTNER, MEMBER, PRESIDENT, TREASURER, AGENT MAKE CHECK OR MONEY ORDER PAYABLE TO: LIMA CITY TREASURER P.O. BOX 155, LIMA, OHIO 45802 FOR PERIOD ENDING DUE ON OR BEFORE JAN, FEB, MAR 2019 APRIL 30, 2019 If Name or Address is Incorrect Make Necessary Change THIS RETURN MUST BE FILED ON OR BEFORE DUE DATE AS SHOWN ABOVE

EMPLOYERS RETURN OF TAX WITHHELD CITY OF LIMA, OHIO DEPT. OF TAXATION FORM LW-1 1. GROSS WAGES SUBJECT TO WITHHOLDING... $ 2. ACTUAL TAX WITHHELD THIS PERIOD... $ If payment is past due, complete below (See instructions) 3. LATE FEE (See instructions)... $ 4. INTEREST (See instructions)... $ 5. PENALTY (See instructions)... $ 6. TOTAL... $ If no wages paid this period mark None and return form with explanation. I HEREBY CERTIFY that the information and statements contained herein and any schedules attached are true and correct. (Signed) (Official Title) Date OWNER, PARTNER, MEMBER, PRESIDENT, TREASURER, AGENT MAKE CHECK OR MONEY ORDER PAYABLE TO: LIMA CITY TREASURER P.O. BOX 155, LIMA, OHIO 45802 FOR PERIOD ENDING DUE ON OR BEFORE APR, MAY, JUN 2019 JULY 31, 2019 If Name or Address is Incorrect Make Necessary Change THIS RETURN MUST BE FILED ON OR BEFORE DUE DATE AS SHOWN ABOVE

EMPLOYERS RETURN OF TAX WITHHELD CITY OF LIMA, OHIO DEPT. OF TAXATION FORM LW-1 1. GROSS WAGES SUBJECT TO WITHHOLDING... $ 2. ACTUAL TAX WITHHELD THIS PERIOD... $ If payment is past due, complete below (See instructions) 3. LATE FEE (See instructions)... $ 4. INTEREST (See instructions)... $ 5. PENALTY (See instructions)... $ 6. TOTAL... $ If no wages paid this period mark None and return form with explanation. I HEREBY CERTIFY that the information and statements contained herein and any schedules attached are true and correct. (Signed) (Official Title) Date OWNER, PARTNER, MEMBER, PRESIDENT, TREASURER, AGENT MAKE CHECK OR MONEY ORDER PAYABLE TO: LIMA CITY TREASURER P.O. BOX 155, LIMA, OHIO 45802 FOR PERIOD ENDING DUE ON OR BEFORE JUL, AUG, SEP 2019 OCTOBER 31, 2019 If Name or Address is Incorrect Make Necessary Change THIS RETURN MUST BE FILED ON OR BEFORE DUE DATE AS SHOWN ABOVE

EMPLOYERS RETURN OF TAX WITHHELD CITY OF LIMA, OHIO DEPT. OF TAXATION FORM LW-1 1. GROSS WAGES SUBJECT TO WITHHOLDING... $ 2. ACTUAL TAX WITHHELD THIS PERIOD... $ If payment is past due, complete below (See instructions) 3. LATE FEE (See instructions)... $ 4. INTEREST (See instructions)... $ 5. PENALTY (See instructions)... $ 6. TOTAL... $ If no wages paid this period mark None and return form with explanation. I HEREBY CERTIFY that the information and statements contained herein and any schedules attached are true and correct. (Signed) (Official Title) Date OWNER, PARTNER, MEMBER, PRESIDENT, TREASURER, AGENT MAKE CHECK OR MONEY ORDER PAYABLE TO: LIMA CITY TREASURER P.O. BOX 155, LIMA, OHIO 45802 FOR PERIOD ENDING DUE ON OR BEFORE OCT, NOV, DEC 2019 JANUARY 31, 2020 If Name or Address is Incorrect Make Necessary Change THIS RETURN MUST BE FILED ON OR BEFORE DUE DATE AS SHOWN ABOVE

City Form LW-3 City of Lima Department of Taxation P.O. Box 155 45802 RECONCILIATION OF RETURNS OF INCOME TAX WITHHELD (FORMS LW-1) WITH W-2 FORMS SUBMITTED HEREWITH FILE ON OR BEFORE THE LAST DAY OF FEBRUARY Do Not Remit With This Form: For Reconciliation Purposes Only. PLEASE REMIT PAYMENTS WITH FORM LW-1 2019 1. Total number of employees as represented by Forms W-2 submitted herewith... 2. Total gross wages subject to withholding... $ 3. Total Income Tax Withheld from compensation paid all Employees... $ 4. Total Income Tax Withheld from compensation as shown by Item 2 of Form LW-1 for the period: First Quarter... $ Second Quarter... $ Third Quarter... $ Fourth Quarter... $ 5. TOTAL... $ Item 3 and 5 should be identical, explain fully any discrepancy.

(Keep for your records - Do not file) Period Due Check Period Due Check Ending Date Amount Date Number Ending Date Amount Date Number 1/31 2/15 7/31 8/15 2/28 3/15 8/31 9/16 3/31 4/15 9/30 10/15 1st Qtr. 4/30 3rd Qtr. 10/31 4/30 5/15 10/31 11/15 5/31 6/17 11/30 12/16 6/30 7/15 12/31 1/15 2nd Qtr. 7/31 4th Qtr. 1/31