INCOME TAX DEPARTMENT 
                                                                                  P.O. Box 862 | Findlay, OH 45839-0862 
                                                                            Ph. 419-424-7133 | Fax: 419-424-7410 | www.findlayohio.gov/incometax 

                                       Form W-3 Employer’s Annual Withholding Reconciliation 

Name 

Address 

City                            ST     Zip 

        - 
Federal employer identification number 

Year (due last day of February) 

Quantity of W-2s attached 

If this account was active for the year solely and entirely for withholding       If line 6 is a negative number, Refund  or    Carry forward   
Findlay tax voluntarily from resident employees, line 1 should be zero.           If positive and greater than $10, make check payable to City of Findlay 

          I certify, to the best of my knowledge and belief, that the information shown above is true, correct, and complete. 

Signature of Responsible Party             Date                             Title                                         Phone