EMPLOYER MUNICIPAL QUARTERLY WITHHOLDING BOOKLET

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DIVISION OF TAXATION CITY OF WESTERVILLE P.O. BOX 130 WESTERVILLE, OHIO 43086-0130 IMPORTANT TAX INFORMATION EMPLOYER MUNICIPAL QUARTERLY WITHHOLDING BOOKLET

IN ORDER TO INSURE PROPER POSTING OF YOUR WITHHOLDING ACCOUNT, PLEASE USE THE ENCLOSED WITHHOLDING FORMS. PLEASE MAKE SURE YOU HAVE YOUR NAME, CURRENT ADDRESS AND FEDERAL ID# ON EACH REMITTANCE TO THE CITY OF WESTERVILLE. THANK YOU FOR YOUR ASSISTANCE.

GENERAL INFORMATION 1. EACH EMPLOYER LOCATED OR DOING BUSINESS WITHIN THE CITY OF WESTERVILLE, OHIO, WHO EMPLOYS ONE OR MORE PERSONS IS REQUIRED TO WITHHOLD THE TAX OF 2.0% FROM ALL EMPLOYEE COMPENSATION AT THE TIME OF PAYMENT, WILL BE PAID ON OR BEFORE THE LAST DAY OF EACH MONTH FOLLOWING THE CALENDAR QUARTER ENDING MARCH 31, JUNE 30, SEPTEMBER 30 AND DECEMBER 31, MAKE A RETURN AND REMIT THE TAX WITHHELD DURING THE PRECEDING CALENDAR QUARTER TO THE INCOME TAX DIVISION, P.O. BOX 130 WESTERVILLE, OHIO 43086-0130. THIS QUARTERLY FILING REQUIREMENT IS APPLICABLE FOR WITHHELD INCOME TAX IN AMOUNTS LESS THAN $100.00 PER MONTH. MONTHLY DEPOSITS ARE REQUIRED WHEN THE TAX LIABILITY IS $ 100.00 OR MORE PER MONTH. MONTHLY DEPOSITS WILL BE RECEIVED NOT LATER THAN 15 DAYS AFTER THE CLOSE OF THE CALENDAR MONTH. SEMI MONTHLY DEPOSITS ARE REQUIRED IF TAXES WITHHELD EXCEED $1,000 PER MONTH. THE RETURNS AND PAYMENTS WILL BE RECEIVED NOT LATER THAN 3 BUSINESS DAYS AFTER THE 15TH AND THE LAST DAY OF THE MONTH. 2. DELINQUENT RETURNS AND PAYMENTS SHALL BE SUBJECT TO PENALTY AND INTEREST AT THE RATE OF 50% PENALTY AND AT.50% PER MONTH, OR FRACTION THEREOF, FOR INTEREST. 3. THE FAILURE OF ANY EMPLOYER TO RECEIVE OR PROCURE FORM WW-1 IS NOT REASONABLE CAUSE FOR FAILING TO MAKE PAYMENT AND TO FILE A RETURN. A RETURN IS DUE FOR EACH REPORTING PERIOD AS REQUIRED, EVEN IF THERE IS NO LIABILITY FOR THAT PERIOD. 4. AN ANNUAL RECONCILIATION IS REQUIRED TO BE FILED WITH COPIES OF FEDERAL FORM W-2 BY FEBRUARY 28 FOLLOWING EACH CALENDAR YEAR. CONTACT OUR OFFICE FOR THE SPEC S FOR THE ACCEPTED FORMAT THAT WILL NEED TO ACCOMPANY THIS COMPLETED W-3. ACCEPTABLE FORMS OF MAGNETIC MEDIA IS A CDROM. 5. ANY PERSON, INCLUDING CORPORATIONS, PARTNERSHIPS, EMPLOYERS, ESTATES AND TRUSTS, WHO FILES 250 OR MORE INFORMATION RETURNS OF FORM W-2 FOR ANY CALENDAR YEAR, MUST FILE THESE RETURNS USING MAGNETIC MEDIA OR SUCH OTHER PROCESS AS DETERMINED ACCEPTABLE TO THE FINANCE DIRECTOR. ALL REQUIREMENTS APPLY SEPARATELY TO BOTH ORIGINAL AND CORRECTED FORMS.

CITY OF WESTERVILLE, OHIO RETURN OF INCOME TAX WITHHELD 1. Tax withheld on income earned in Westerville, (2.0% rate)... $ 2. Residence tax withheld... $ 3. Adjustments to Prior Returns... $ 4. Balance Due with this Form. Pay this amount in FULL... $ 5. Late Payment Penalty Charge (50%)... $ 6. Late Interest Charge at.50% per month... $ 7. TOTAL DUE (Make check payable to City of Westerville)... $ (see Page 1 For Instructions) WW-1 FOR CITY USE ONLY Federal I.D. No. File With: City of Westerville Income Tax Division P.O. Box 130 Westerville, Ohio 43086-0130 (614) 901-6420 FAX (614) 901-6820 FOR THE PERIOD ENDING MARCH 31, 2017 I declare that this has been examined by me, and to the best of my knowledge and belief it is a true, correct and complete return, made in good faith, pursuant to City of Westerville Income Tax Ordinance and regulations. (Signed) (Title) Date Please make corrections if necessary RECEIVED ON OR BEFORE APRIL 30, 2017 If you did not have any Employees or withheld income tax for this period, please indicate and return this form.

CITY OF WESTERVILLE, OHIO RETURN OF INCOME TAX WITHHELD 1. Tax withheld on income earned in Westerville, (2.0% rate)... $ 2. Residence tax withheld... $ 3. Adjustments to Prior Returns... $ 4. Balance Due with this Form. Pay this amount in FULL... $ 5. Late Payment Penalty Charge (50%)... $ 6. Late Interest Charge at.50% per month... $ 7. TOTAL DUE (Make check payable to City of Westerville)... $ (see Page 1 For Instructions) WW-1 FOR CITY USE ONLY Federal I.D. No. File With: City of Westerville Income Tax Division P.O. Box 130 Westerville, Ohio 43086-0130 (614) 901-6420 FAX (614) 901-6820 FOR THE PERIOD ENDING JUNE 30, 2017 I declare that this has been examined by me, and to the best of my knowledge and belief it is a true, correct and complete return, made in good faith, pursuant to City of Westerville Income Tax Ordinance and regulations. (Signed) (Title) Date Please make corrections if necessary RECEIVED ON OR BEFORE JULY 31, 2017 If you did not have any Employees or withheld income tax for this period, please indicate and return this form.

CITY OF WESTERVILLE, OHIO RETURN OF INCOME TAX WITHHELD 1. Tax withheld on income earned in Westerville, (2.0% rate)... $ 2. Residence tax withheld... $ 3. Adjustments to Prior Returns... $ 4. Balance Due with this Form. Pay this amount in FULL... $ 5. Late Payment Penalty Charge (50%)... $ 6. Late Interest Charge at.50% per month... $ 7. TOTAL DUE (Make check payable to City of Westerville)... $ (see Page 1 For Instructions) WW-1 FOR CITY USE ONLY Federal I.D. No. File With: City of Westerville Income Tax Division P.O. Box 130 Westerville, Ohio 43086-0130 (614) 901-6420 FAX (614) 901-6820 FOR THE PERIOD ENDING SEPTEMBER 30, 2017 I declare that this has been examined by me, and to the best of my knowledge and belief it is a true, correct and complete return, made in good faith, pursuant to City of Westerville Income Tax Ordinance and regulations. (Signed) (Title) Date Please make corrections if necessary RECEIVED ON OR BEFORE OCTOBER 31, 2017 If you did not have any Employees or withheld income tax for this period, please indicate and return this form.

CITY OF WESTERVILLE, OHIO RETURN OF INCOME TAX WITHHELD 1. Tax withheld on income earned in Westerville, (2.0% rate)... $ 2. Residence tax withheld... $ 3. Adjustments to Prior Returns... $ 4. Balance Due with this Form. Pay this amount in FULL... $ 5. Late Payment Penalty Charge (50%)... $ 6. Late Interest Charge at.50% per month... $ 7. TOTAL DUE (Make check payable to City of Westerville)... $ (see Page 1 For Instructions) WW-1 FOR CITY USE ONLY Federal I.D. No. File With: City of Westerville Income Tax Division P.O. Box 130 Westerville, Ohio 43086-0130 (614) 901-6420 FAX (614) 901-6820 FOR THE PERIOD ENDING DECEMBER 31, 2017 I declare that this has been examined by me, and to the best of my knowledge and belief it is a true, correct and complete return, made in good faith, pursuant to City of Westerville Income Tax Ordinance and regulations. (Signed) (Title) Date Please make corrections if necessary RECEIVED ON OR BEFORE JANUARY 31, 2018 If you did not have any Employees or withheld income tax for this period, please indicate and return this form.

INSTRUCTIONS 1. Indicate the number of employees/number of W2 s submitted. 2. Total of Westerville wages as shown on W2 s. 3. Total of Westerville Tax withheld as shown on W2 s. 4. If you file withholding taxes monthly or semi-monthly, list each month s total payment and then record the total for the year on line 4. If you file quarterly withholding, list each quarter s deposit and then record the total for the year on line 4. Any discrepancy between the amounts shown on lines 3 and 4 must be explained in an attached statement. If additional tax is due payment must be included and mailed with this report. Penalty and interest will be assessed where applicable. If name, address or identification number is incorrect, please make corrections. If this is a Final Return, please indicate. Mail reconciliation with W2 copies by February 28 to City of Westerville, Income Tax Division, P.O. Box 130, Westerville, Ohio 43086-0130.

Reconciliation Returns of Income Tax Withheld for Westerville, Ohio, YEAR WW-3 Date Due: February 28 1. Total Westerville W-2 s... 2. Wages Subject to Withholding Tax 3. Amount of Tax Withheld... 4. Total Tax Paid... Federal I.D. No. W-2 s must be attached. If you filed monthly or semi-monthly returns, record each months total deposits below: JAN FEB MAR APR MAY JUNE 1ST QTR 2ND QTR JULY AUG SEPT OCT NOV DEC If you filed quarterly, record each quarter s deposit below: 3RD QTR 4TH QTR I hereby certify that the information and statements contained herein are true and correct. (Signed) Please make corrections if necessary (Title) Date

QUARTERLY WITHHOLDING TAX WORKSHEET (Keep for your records - Do not file) Quarter Ending Payment Date Check Number Date Amount 3/31 4/30 6/30 7/31 9/30 10/31 12/31 1/31