Phone: (937) 296-2502 • Fax: (937) 296-3242 
                                                              Email: ketteringtax@ketteringoh.org 
           Income Tax Division                                Website: www.ketteringoh.org 
P.O. Box 639409, Cincinnati, OH 45263-9409 
 
     EMPLOYER QUARTERLY RETURN OF CITY TAX WITHHELD (FORM KW1) 
 
Tax Year                                                                                        
Quarter Ending Date                                                                             
Due Date                                                                                        
FEIN                                                                                            
Account Number                                                                                  
                                                                                   
1.  Total Wages Subject To Kettering Tax                                          $ 
2.  Kettering Tax Withheld (Rate 2.25%)                                            
3.  Adjustments (explain in space provided below)                                  
4.   Total Due                                                                    $ 

Business Name, Address, City, State, Postal Code                                     Tax Rate: 2.25% 

                                                                                    Courtesy  
                                                                                    Withholding  
                                                                                     
                                                                                    Amended Return 
                                                                                     
                                                                                    Final Return 

                                                                                    (If amended or final, 
                                                                                    please explain below) 
 
Responsible Officer Signature              Date       Responsible Officer Name (Please Print)  
 
Line 3 Adjustments (Please explain here):                                                                  
                                                                                                            
Amended Return (Please explain here):                                                                      
                                                                                                           
Final Return (Please provide additional information: 
 
Out of Business:                           Merged:                     Other:                              
 
Effective Date:                            Effective Date:             Effective Date:                     
                                                      
Survivor / New Owner Name and Address: 
 
Survivor / New Owner FEIN 
 
Will you reconcile tax withheld now?              or with surviving corporation?  
 
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