INSTRUCTIONS FOR FILING RECONCILIATION OF RETURNS FOR TAX YEAR 2022

GENERAL INFORMATION
On   or before February 28th   of each year, every       employer   must  file a   withholding Reconciliation   of   Returns. (This     filing will   
include wages reportable and        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
All Reconciliations   of Returns plus attachments must             be mailed       to   City of Fairfield, Division   of Taxation, 701 Wessel        
Dr., Fairfield, OH 45014.

In the appropriate boxes,       enter the amounts   of   tax withheld for each     period, the number  of employees   (Box A),     the  total          
compensation subject   of       City of Fairfield Income Tax (Box B), the tax due on said compensation   at           1.5% (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  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.        
Overpayments   of less than $10.00 will not be refunded.           Be sure to attach copies of all W-2 forms.

                                                                                   Account #   ______________________________
                                                                                   FEIN      ________________________________

2022 City of Fairfield                                           ANNUAL RECONCILIATION OF RETURNS
                                                                                     JANUARY                        JULY
Business Name
                                                                                     FEBRUARY                       AUGUST

Mailing Address                                                                      MARCH/1ST QTR                  SEPTEMBER/3RD QTR

                                                                                     APRIL                          OCTOBER
SUBMIT BY FEB 28, 2023.  W-2'S MUST BE ATTACHED.
                                                                                     MAY                            NOVEMBER
I hereby certify that the information and statements contained herein are true and 
correct.
                                                                                     JUNE/2ND QTR                   DECEMBER/4TH QTR

Printed Name of Responsible Party
                                                                                     Box A      Number of employees:
Signature of Responsible Party                             Phone                     Box B     Total Gross Compensation:
Date                                       E-mail:
                                                                                     Box C     Tax Due at  1.5%:

MAIL TO:        City of Fairfield                                                    Box D Tax Withheld :
                Division of Taxation                                                 Box E     Tax Paid:
                701 Wessel Dr.                                                       Box F     Balance Due or (Overpayment):
                Fairfield, OH 45014
FORM TW-3