City of Fairfield 
                                                                                       Annual 
                                                                                                                            Income Tax Division                 Phone: 513-867-5327
                                                                               Reconciliation                               701 Wessel Dr                       Fax: 513-867-5333
                                                                                                                            Fairfield, OH 45014  
                                                                                       Submit by 
                                                                                                                            www.fairfield-city.org 
                                                                                 February 29, 2024 

GENERAL INFORMATION
On   or before the last day of February each year                        , every employer must file   a withholding Reconciliation. This                            filing will   
include the tax paid in the      prior calendar year                    on employee           withholding        for the      City of Fairfield.           Copies   of all W-2   
forms applicable   to the Reconciliation                must          be attached. All        W-2's   must       furnish  the employee's           name,   address,      full social 
security number, qualifying wage compensation, and                                City of Fairfield              tax withheld. If more    than     one     city tax was withheld,    
then the W-2's must show   a breakdown of each city for                                which  tax    was      withheld,    the wages     earned    in   each city,  and the 
amount of city tax withheld for each city.

RECONCILIATION FORM INSTRUCTIONS
In the appropriate boxes,    enter the        amounts                 of   tax withheld       for each        period, the number      of employees        (Box A),  the total         
compensation subject to City of Fairfield                      Income Tax (Box B), the tax due on said compensation   1.5 at                               % (Box C), the amount 
of tax withheld (Box   D),   the amount       paid             (Box E), and            any    difference      (Box F).   If there  is a shortage        greater than                  
$10.00, this balance due must    be           remitted immediately.                    Any    withholding         shortage         , late payment,         or missed payment
will be subject to   penalty and              interest                charges.            If  there           is  an   overpayment                 greater than     $10.00,      you 
must    attach     an explanation.            An overpayment   of tax from an                         individual      employee's      wages        will only be  refunded        
directly   to the employee.      Non-resident employees must complete a separate non-resident refund request.                                              Overpayments   of
less than $10.00 will not be refunded.                  Be sure to attach copies of all W-2 forms.

Mail Completed Reconciliation and W-2 Forms to:
City of Fairfield 
Income Tax Division
701 Wessel Dr.
Fairfield, OH 45014

                                                                                                                 Inactivate Account
                   2023 City of Fairfield                                                                       W-2(s) Attached REQUIRED (electronic file
                   Annual Reconciliation                                                                        for importing perferred, see website for details)
                                                                                                                 JANUARY                           JULY

Business Name             ___________________________                                                            FEBRUARY                          AUGUST

               FEIN       _____________________________________                                                  MARCH/1ST QTR                     SEPTEMBER/3RD QTR
                                                                                                                 APRIL                             OCTOBER
Mailing Address           ___________________________
                                                                                                                 MAY                               NOVEMBER
________________________________________
                                                                                                                 JUNE/2ND QTR                      DECEMBER/4TH QTR

   SUBMIT BY FEB 28, 2024.  W-2'S MUST BE ATTACHED.

I hereby certify that the information and statements contained herein are true and                               Box A     Number of employees:
correct.                                                                                                         Box B     Fairfield Wages:

                                                                                                                 Box C     Tax Due at  1.5%:
Signature
                                                                                                                 Box D Tax Withheld :
Contact Person & Email                                                                                           Box E     Tax Paid:
                                                                                                                 *Box F Balance Due or Overpayment:
Date                                                           Phone                                                       *If greater than $10.00