TAX YEAR 20__                                       CITY OF READING 
FORM W3                                               1000 MARKET STREET 
WITHHOLDING                                         READING OH  45215 
RECONCILIATION                             Phone (513) 733-0300 Fax (513) 842-1016 
 
DUE DATE:  02/28/__ 
 
                                                    Federal ID Number    ____________________ 
Name 
                                                    Name of Person 
  And                                               Completing Form      ____________________ 
 
Address                                             Phone Number         ____________________ 
                                                    Number of Employees  ____________________ 
 
         EMPLOYEE W2’S OR 1099S FOR SUB-CONTRACTORS MUST ACCOMPANY THIS FORM 
                                              INSTRUCTIONS 
 1.  Attach check payable to CITY OF READING, for difference if withholding exceeds remittance. 
 2.  If remittance exceeds amount withheld, give explanation and overpayment can be refunded or applied to the 
       next month or quarter due. 
 3.  Attach explanation if column 2 is used. 
 
                             ENTER PAYROLL BY QUARTERLY OR MONTHLY TOTALS 
                     (1)                     (2)    (3)                  (4)                    (5) 
                     Gross           Payroll Not    Payroll              Tax                    Tax Paid 
Period               Payroll         Subject to Tax Subject to Tax       Due           Per Your Records 
                                                                                                 
January           _______________  _______________  _______________  _______________   _______________ 
February          _______________  _______________  _______________  _______________   _______________ 
March / Qtr–1     _______________  _______________  _______________  _______________   _______________ 

April             _______________  _______________  _______________  _______________   _______________ 
May               _______________  _______________  _______________  _______________   _______________ 
June / Qtr–2      _______________  _______________  _______________  _______________   _______________ 

July              _______________  _______________  _______________  _______________   _______________ 
August            _______________  _______________  _______________  _______________   _______________ 
September / Qtr–3 _______________  _______________  _______________  _______________   _______________ 

October           _______________  _______________  _______________  _______________   _______________ 
November          _______________  _______________  _______________  _______________   _______________ 
December / Qtr-4  _______________  _______________  _______________  _______________   _______________ 
                                                                                                 
TOTALS                                                                                           
                  =============      =============  =============        ============= ============= 
                                                                                                 
TOTAL REMITTANCE MADE  ______________ 
DIFFERENCE               ______________ 
 
Employer – Explain any differences: