DELAWARE DIVISION OF REVENUE                                                                           *DF60116019999*
               ANNUAL RECONCILIATION OF DE INCOME TAX WITHHELD               FORM W3A 9801
                  ACCOUNT NUMBER                             FOR OFFICE USE ONLY                       TAX PERIOD ENDING        DUE ON OR BEFORE      DF60116019999
                                                                                                   12-31-17                     02-28-18
                                                                                                                                                      W8

     Mail This Form With Remittance                   CHANGES MUST BE                 1.  Amount of Delaware Wages
     Payable To:                                      MADE ON THE REQUEST 
     STATE OF DELAWARE                                FOR CHANGE FORM. 
     DIVISION OF REVENUE                              CHECK THE BOX IF YOU            2. Number of Withholding Statements  
     P.O. BOX 830                                     ARE FILING A CHANGE                 (Form W-2 and/or 1099 attached.)
                                                      FORM.
     WILMINGTON, DE 19899-0830 
     If you have questions, call (302) 577-8779                                       3. Total Delaware Income Tax WITHHELD  
               CHECK THE BOX IF W-2(S) AND/OR 1099s                                   from Wages (as shown on attached forms.)
               ARE BEING SUBMITTED ELECTRONICALLY.
                                                                                      4. Total Delaware Income Tax PAID during  
                                                                                      the year from back of this form.
                                                                                      5. Difference between Line 3 and Line 4
                                                                                        Overpayment               Balance Due
                                                                                      (Please remit Balance Due. Do not apply Refund Due to future payments. Refund will be issued from this document.)

               X                                                                      TELEPHONE NUMBER                                       DATE M M D D Y Y
               AUTHORIZED SIGNATURE I declare under penalties of perjury that this is 
                                    a true, correct and complete return.              EMAIL ADDRESS

                                                                                                                                      Reset           Print Form
                                                             Delaware Withholding
                                     8th-Monthly Annual Reconciliation Form W-3

                                                                                                        January 

2000-1 and 2001-5.) You must also include a copy of all 1099’s on which Delaware withholding tax is indicated. 
Using the worksheet below: Enter the amount of tax withheld and tax paid for each month of the year from your payroll records. 
On the return: 
     Line 1 - Enter the total amount of the Delaware wages.  
     Line 2 - Enter the total number of W-2s and/or 1099s. Add the amount of Delaware Income Tax Withheld (per W-2s and 1099s), compare that amount to the 
amount withheld from the back of this return. These amounts must equal, if they do not, determine where the error occurred and make any necessary correction(s) 

     Line 3  -Enter the total corrected Delaware Income Tax withheld. 
     Line 4 - Enter the amount of Tax Paid from the back of the return. Subtract Line 4 from Line 3. If Line 4 is greater than Line 3, then an Overpayment exists 
and you should check the Overpayment box. Be sure to attach an explanation of  how the overpayment occurred. DO NOT take a credit for any overpayment 
on your next return.  An overpayment existing at the end of the calendar year cannot be carried over to the next calendar year. If Line 3 is less than Line 4, an 
Underpayment exists and you must check the Balance Due box and remit the total amount due with this return. Section 537 of Title 30 of the Delaware Code 
provides that no credit or refund will be made to any employer if the employer was required and deducted Delaware withholding taxes from its employees. In such 

                                                                         (CUT ON LINE ABOVE)
                                                             WITHHOLDING WORKSHEET
               TAX PAID                               TAX WHITHHELD                                                          TAX PAID                 TAX WITHHELD

Jan.                                                                                               July
Feb.                                                                                               Aug.
Mar.                                                                                               Sept.
Apr.                                                                                               Oct.
May                                                                                                Nov.
June                                                                                               Dec.

TOTAL TAX PAID FOR THIS YEAR                                                                       TOTAL TAX WITHHELD                        
(Enter amount on Line 4)                            $                                 0            (Should agree with Line 3)                     $                                                    0