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2017    CITY OF ASHTABULA OHIO, EMPLOYER’S RETURN OF TAX WITHHELD                                                         AMENDED               Return with Payment
No. of Employees Represented on line No. 1 Below                                                          I hereby certify that the information and statements
1. Taxable Earnings paid all Employees subject to                                                         contained herein are true and correct.
City of Ashtabula, Ohio, 1.8% (.018) Income Tax
Is this a courtesy withholding? YES                                                                       (Signed)
Is this a final return?         YES NO
If yes, attach explanation                                1                                               (Official Title)
                                                                                                                                                              Date
2. Actual Tax Withheld in reporting period for City                                                       Federal ID No.
Income Tax                                                2
3. Adjustment of Tax for prior quarter (see instructions) 3                                               Email
4. Penalty (See Instructions)                             4                                               Phone
5. Interest (See Instructions)                            5                                                               THIS RETURN MUST BE FILED
6. Total – (Lines 2-5)                                    6                                                    ON OR BEFORE THE DUE DATE SHOWN BELOW
                                                                                                                  MAKE CHECK OR MONEY ORDER PAYABLE TO:
If no wages paid this quarter, mark “NONE” and return this form with explanation.                                         ASHTABULA CITY - INCOME TAX
EMPLOYER NAME/ADDRESS                                       FOR THE MONTH(S) OFPlease select period below                 MAIL TO: 
                                                                                                                          CITY OF ASHTABULA
                                                                                                                          INCOME TAX DEPARTMENT
                                                            MUST BE RECEIVED BY                                           4717 MAIN AVE, STE A
                                                                                                                          ASHTABULA, OHIO 44004
                                                                                                                          VOICE (440) 992-7104
                                                                                                                  If receipt is desired, submit additional copy
Notify the Income Tax Department promptly of any change in ownership.                                             and enclose self-addressed, stamped envelope.
FORM W-1

(Enter TOTAL Line 5,

                                                                                                            Return to Form       Print Instructions/Worksheet

                                                 PREPARING AND FILING FORM W-1
Enclosed  is  the  information  and  forms  needed  to  prepare  and  file    Late Payment Penalty – Up to 50% of the total tax due
employer’s MONTHLY or QUARTERLY returns of tax withheld.  This                Interest –See City website at www.cityofashtabula.com for rates 
booklet contains a form for each calendar month or quarter to be returned              (Interest is based on the Federal rate and may change annually)
to the city of Ashtabula Tax Department.
WHO MUST FILE:                                                                INSTRUCTIONS TO PREPARE FORM W1:
 Each employer within, or doing business within, the City of                  Line 1 – Total salaries, wages, commissions, bonuses and other compensation 
Ashtabula who employs one or more persons is required to Withhold City        paid all taxable employees during period for which return is made. If no 
income tax of 1.8% from all wages, salaries, commissions, bonuses and         compensation is paid during the quarter mark “none” and return Form W1.
other compensation paid employees and to file Form W1 and  remit tax to       Line 2 –  Enter tax withheld or required to be withheld during the period for 
the City of Ashtabula Income Tax Department.                                  which the return is made.
DUE DATES:                                                                    Line  3  – Adjust  current  payment  of  actual  tax  withheld  for  underpayment  or 
 Monthly returns are required if withholding tax exceeds $200 per month       overpayment in previous period. Attach explanation.
and are due on the fifteenth (15th) day of the next month. Quarterly returns 
are required of all other employers and are due on the last day of the month  Line 4 – If payment/return is past due, enter up to 50% of the amount of Line 2 plus 
following the last day of each calendar quarter.                              $25 per month or fraction of a month for a maximum up to 6 months ($150) (Penalty)
                                                                              Line 5 – If payment/return is past due, enter Line 2 times the monthly interest 
PENALTIES AND INTEREST:                                                       rate for each month or fraction of month past due. See City website at
 Any late filings or unpaid taxes are subject to penalty and interest charges www.cityofashtabula.com for rates.
as follows: 
 Late File Penalty – $25 per month or fraction of a month with a maximum      Line 6 – Enter total to be remitted
of $50.                                                                       Payments received after the due date or post-marked after the due date are 
                                                                              subject to penalty and interest charges.

                      Withholding Tax Worksheet                                                        Withholding Tax Worksheet
               (Keep for your records – Do not file)                                             (Keep for your records – Do not file)
  Month     Due                                                                Month        Due
  Ending  Date        Check#            Date     Amount                        Ending  Date              Check#       Date              Amount

  1/31      2/15      ________          ________ ________                      7/31         8/15         ________     ________          ________

  2/28      3/15      ________          ________ ________                      8/31         9/15         ________     ________          ________

  3/31      4/15      ________          ________ ________                      9/30         10/15        ________     ________          ________

 or 1st qtr 4/30      ________          ________ ________                     or 3rd qtr    10/31        ________     ________          ________

  4/30      5/15      ________          ________ ________                      10/31        11/15        ________     ________          ________

  5/31      6/15      ________          ________ ________                      11/30        12/15        ________     ________          ________

  6/30      7/15      ________          ________ ________                      12/31        1/15         ________     ________          ________

 or 2nd qtr  7/31     ________          ________ ________                     or 4th qtr    1/31         ________     ________          ________