Collector of Revenue           EMPLOYER’S MONTHLY DEPOSIT FORM                                       (INSTRUCTIONSW-11OF 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

                                     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