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                                   DWM-1 Employer’s Monthly Return of City Tax Withheld 

                                                                       Tax Year                                   Period 

  EIN/FID Number:                                       W              Choose an item.Choose an item.      Choose an item.Choose an item.    
 
  Employer Name:                                                       Should this account be inactivated?  ☐YES   ☐ No 
                                                                       IF YES 
  Address:                                                             Please explain                                      
                                                                        
                                                                       Effective date                                      
  City:                               State:         Zip:          
                                                                        
  WITHHOLDING INFORMATION 
 
              QUALIFYING         TAX           TAX DUE       PENALTY  INTEREST          TOTAL            LESS PRIOR      NET DUE 
                WAGES           RATE                                                      DUE             PAYMENT 
                                                                                                                      
  Dublin 
  Workplace                     2% 

  Dublin                                                                                                              
  Remote                        2% 
  Work 
                                                                                                                      
  Courtesy* 

*Courtesy is for tax due from residents working in cities with a 
                                                                     TOTAL 
lower tax rate or no local tax                                  

                                                                                      **Please do not remit amounts of $10.00 or less
                         
  Complete this section ONLY if you are AMENDING a prior return         
                                 Explanation for Changes:                                                                    

                                                                                                                Difference 
  Wages Originally Reported       Tax Originally Remitted  Corrected Wages              Corrected Tax Due       (Tax Originally remitted 
                                                                                                                less corrected tax due) 
                                                                                                                 
                                                                                      **Please do not remit amounts of $10.00 or less          
If difference is a negative, please indicate how you would like to handle the adjustment: 
REFUND     ☐                                   CREDIT THE ADJUSTMENT FORWARD TO NEXT QUARTER                                             ☐ 
 
  SIGNATURE 
 
OFFICER NAME/TITLE (Please print)                                     OFFICER SIGNATURE 
 
                                                                      DATE:                                                                   
Make checks payable to:         Dublin Division of Taxation 
Mail to:                        PO Box 9062                           PHONE:                                              
                                Dublin, Ohio 43017-0962