UNION COUNTY TAX ADMININSTRATOR                                    HOW TO RECONCILE YOU PAYROLL WIHTHOLDING: 
                                                                                Enter under TAXABLE PAYROLL the quarterly total of all employees for services  
             RECONCILIATION OF LICENSE FEE WITHHELD                             within Union County. Enter the balance for each quarter under TOTAL TAX DUE. 
                     DURING THE YEAR ENDED                                      All compensation, i.e. Vacation, Sick, and Holiday Pay, is t be included in the  
                                                                                payroll totals.  A copy of all W-2's and W-3 Control Sheet is to be turned in to the  
             *PLEASE MADE A COPY OF THIS FORM FOR YOUR RECORDS                  County as per the ordinance. 
                                             TOTAL PAYROLL                      TAXABLE  PAYROLL                                     TOTAL TAX DUE

1. 1st Quarter ended March 31                                                                                x 1/2 %

2. 2nd Quarter ended June 30                                                                                 x 1/2 %

3. 3rd Quarter ended September 30                                                                            x 1/2 %

4. 4th Quarter ended December 31                                                                             x 1/2 %

5. TOTAL ALL QUARTERS

6. Actual withholding payments made quarterly on Occupational Tax Form
7. Difference between line 5 and 6 ( if any, check applicable block below)

Signature                                                                 Title                                      Date
Name:                                        No of employees                    Any balance due is to be paid and shown on Payroll 
                                                                                Tax Form line 3, as an adjustment.
Address:                                     Account No.                        Any overpayment is to be:
                                                                                                             credited to next quarter
City                                         Federal ID No.
                                                                                                             refunded
State     AL                      Zip:       Phone Number
                                       To Be Filed With The 4th Quarter's Return By January 31