FORM W1    EMPLOYER’S WITHHOLDING FORM QUARTERLY/MONTHLY                       TAX YEAR 20_ _ 
 1. Number of Taxable Employees                                                                                 PERIOD 
                                                  1 
 2. Total Salaries, Wages, Commissions and other                                                               QUARTERLY 
     Compensation paid all employees              2 
                                                                                                               __   JAN THRU MARCH DUE 04/30 
 3. Taxable Earnings (from line 2)                3                                                            __   APRIL THRU JUNE  DUE 07/31 
                                                  4                                                            __   JULY THRU SEPT.   DUE 10/31 
 4. Actual Tax Withheld at 2.0%                                                                                __   OCT. THRU DEC.     DUE 01/31 
 5. Adjustments of Tax for Prior Period           5                                           
 6. Total (Include Interest and Penalty if Due)   6                                                            MONTHLY 
                                                                                                  Due Date 15 thof the following month 
                                                                                                             MONTH END __________  
                                                                                                                    
                                                                                                 I  hereby  certify  that  the  information  and  statements 
                                                                                                 contained here in  and  in  any schedules  attached  are true 
                                                                                                 and correct. 
                                                                                                                                        
                                                                                                 Signed  ________________________________________ 
                                                                                                 Title _______________________Date _______________ 
                                                                                                 Phone #________________________________________ 
                                                                                                                    
Name                                                                                TAX ID:       MAKE CHECK OR MONEY ORDER TO: 
                                                                                                               CITY OF READING 
  And                                                                                                          EARNINGS TAX ACCOUNT 
                                                                                                               PO BOX 640863 
                                                                                                              CINCINNATI OH 45264-0863 
Address                                                                                           Phone (513) 733-0300       Fax (513) 842-1016 
NOTIFY INCOME TAX DEPARTMENT PROMPTLY OF ANY CHANGE IN OWNERSHIP OR NAME AND ADDRESS