INSTRUCTIONS

 Every employer that withholds a net amount of $1500.00 or more earnings tax during either of the first two months of any
quarter, must deposit the amount withheld  with the Collector  of Revenue, using Form W-11, not later than 15 days after the end
of the month for which withheld.

 If  the net amount withheld  for the first month of the quarter is less than $1500.00 and the net amount withheld for the
second month is $1500.00 or more, the amount withheld for the first  month  is  added  to the  amount  withheld  for the  second
month and submitted with the second month deposit to the Collector of Revenue, using Form W-11, not later than 15 days after
the end of the second month.

 Whenever the net amount for each of the first two months of the quarter is less than $1500.00 and no deposit has been made, 
the total amount withheld for both months is to be included with the amount withheld for the third month and is to be paid to the Collector, 
using Form W-10, not later than the last day of the month following the end of the quarter.

 Net amount  of tax withheld - the gross  amount  of tax withheld from the wages of employees, in either of the first two
months of the quarter.

                                Phone: (314) 622-4071             Website: www.stlouiscollector.com

     Collector of Revenue           EMPLOYER’S MONTHLY DEPOSIT FORM                     (INSTRUCTIONSW-11ON REVERSE SIDE)
     City of St. Louis              EARNINGS TAX WITHHELD
                  Fed. I.D. Number  Quarter Ending                             Enter net amount of tax withheld in proper month

                                                                               January                  July
                                                                             $          $
     MAKE CHECKS PAYABLE TO: GREGORY F.X. DALY, COLLECTOR OF REVENUE
     MAIL TO: EARNINGS TAX DIVISION, P.O. BOX 66966, ST. LOUIS, MO 63166-6966
                                                                               February               August
                                                                             $          $
Date                      Signature            Title
                                                                               April                  October
                                                                             $          $

                                                                               May                    November
                                                                             $          $
                                                                                     Amount of Deposit