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ANNUAL RECONCILIATION                                                             CITY OF ST MATTHEWS
Employer's Annual Reconciliation of Taxes Withheld and Quarterly Payments
Shown by Employer's Quarterly Returns of License Fees Withheld (SMW-1)
                                                                                  6.  TOTAL TAX REMITTED ON 
1. QUARTER ENDED MARCH 31:     FOR CALENDAR YEAR                                  QUARTERLY RETURNS:
                                                                                  7.  TOTAL TAX WITHHELD PER 
2. QUARTER ENDED JUNE 30:                                                         EMPLOYEE STATEMENTS ATTACHED:

                                                                                  ANY DESCRPANCY BETWEEN THE AMOUNTS SHOWN ON 
3. QUARTER ENDED SEPTEMBER 30: DUE ON BEFORE
                                                                                  LINES 6 & 7 MUST BE FULLY EXPLAINED IN AN ATTACHED 
                                                                                  STATEMENT. 
4. QUARTER ENDED DECEMBER 31:
                                                                                  ATTACH LIST OF EMPLOYEES' NAME, ADDRESS, SOCIAL 
5. TOTAL REMITTED FOR YEAR:    ACCOUNT NUMBER                                     SECURITY NUMBER, GROSS PAY, THE AMOUNT SUBJECT TO 
                                                                                  ST. MATTHEWS EMPLOYEE WITHHOLDING TAX, AND TAX 
SMW-3                                                                             DEDUCTED AND PAID TO ST. MATTHEWS. 
                                                                         MAIL TO: CITY OF ST MATTHEWS
                                                                                  3940 GRANDVIEW AVENUE
NOTIFY CITY OF ANY CHANGE IN OWNERSHIP, NAME, OR ADDRESS                          LOUISVILLE KY 40207

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ANNUAL RECONCILIATION                                                             CITY OF ST MATTHEWS
Employer's Annual Reconciliation of Taxes Withheld and Quarterly Payments
Shown by Employer's Quarterly Returns of License Fees Withheld (SMW-1)
                                                                                  6.  TOTAL TAX REMITTED ON 
1. QUARTER ENDED MARCH 31:     FOR CALENDAR YEAR                                  QUARTERLY RETURNS:
                                                                                  7.  TOTAL TAX WITHHELD PER 
2. QUARTER ENDED JUNE 30:                                                         EMPLOYEE STATEMENTS ATTACHED:

                                                                                  ANY DESCRPANCY BETWEEN THE AMOUNTS SHOWN ON 
3. QUARTER ENDED SEPTEMBER 30: DUE ON BEFORE
                                                                                  LINES 6 & 7 MUST BE FULLY EXPLAINED IN AN ATTACHED 
                                                                                  STATEMENT. 
4. QUARTER ENDED DECEMBER 31:
                                                                                  ATTACH LIST OF EMPLOYEES' NAME, ADDRESS, SOCIAL 
5. TOTAL REMITTED FOR YEAR:    ACCOUNT NUMBER                                     SECURITY NUMBER, GROSS PAY, THE AMOUNT SUBJECT TO 
                                                                                  ST. MATTHEWS EMPLOYEE WITHHOLDING TAX, AND TAX 
SMW-3                                                                             DEDUCTED AND PAID TO ST. MATTHEWS. 
                                                                         MAIL TO: CITY OF ST MATTHEWS
                                                                                  3940 GRANDVIEW AVENUE
NOTIFY CITY OF ANY CHANGE IN OWNERSHIP, NAME, OR ADDRESS                          LOUISVILLE KY 40207