INCOME TAX DEPARTMENT 
                                                                                                                  P.O. Box 862 | Findlay, OH 45839-0862
                                                                            Ph. 419-424-7133 | Fax: 419-424-7410 |  www.findlayohio.gov/incometax 

                                              Form W-3 Employer’s Annual Withholding Reconciliation 

                                                                            Total payroll for the year…….….…………..____________________________.________ 

____________________________________________________              1. Total payroll subject to Findlay tax…..____________________________.________ 
Name 

____________________________________________________              2. Liability (one percent of line 1)…………____________________________.________ 
Address 

____________________________________________________              3. Tax withheld from employees…….……..____________________________.________ 
City                                      ST    Zip 

___________-________________________________________              4. Greater of line 2 or line 3……….…………..____________________________.________ 
Federal employer identification number 

___________________                                               5. Amount remitted to Findlay………………..____________________________.________ 
Year  (due last day of February) 

________________                                                  6. Line 4 minus line 5………………………………____________________________.________ 
Quantity of W-2s attached 

If this account was active for the year solely and entirely for withholding                  If line 6 is a negative number, Refund ____    or    Carry forward ____ 
Findlay tax voluntarily from resident employees, line 1 should be zero.                    If positive and greater than $10, make check payable to City of Findlay 

        I certify, to the best of my knowledge and belief, that the information shown above is true, correct, and complete. 

_____________________________________________________________                _____________________________________________________________ 
Signature of Responsible Party                         Date                        Title                           Phone