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2022    CITY OF BRUNSWICK OHIO, EMPLOYER’S RETURN OF TAX WITHHELD                                                             AMENDED               Return with Payment
No. of Employees Represented on line No. 1 Below                                                              I hereby certify that the information and statements
1. Taxable Earnings paid all Employees subject to                                                             contained herein are true and correct.
City of Brunswick, Ohio, 2% (.02) Income Tax
Is this a courtesy withholding? YES                                                                           (Signed)
Is this a final return?         YES         NO
If yes, attach explanation                                    1                                               (Official Title)
                                                                                                                                                                  Date
2. Actual Tax Withheld in reporting period for City                                                           Federal ID No.
Income Tax                                                    2
3. Adjustment of Tax for prior quarter (see instructions)     3                                               Email
4. Penalty (See Instructions)                                 4                                               Phone
5. Interest (See Instructions)                                5                                                               THIS RETURN MUST BE FILED
6. Total – (Lines 2-5)                                        6                                                    ON OR BEFORE THE DUE DATE SHOWN BELOW
                                                                                                                      MAKE CHECK OR MONEY ORDER PAYABLE TO:
If no wages paid this quarter, mark “NONE” and return this form with explanation.                                             CITY OF BRUNSWICK, OHIO
EMPLOYER NAME/ADDRESS                                           FOR THE MONTH(S) OFPlease select period below                 MAIL TO: 
                                                                                                                              INCOME TAX OFFICE
                                                                                                                              CITY OF BRUNSWICK
                                                                MUST BE RECEIVED BY                                           P.O. Box 0816
                                                                                                                              Brunswick, Ohio 44212-0816
                                                                                                                              (330) 558-6815
                                                                                                                              www.brunswick.oh.us/income-tax/
Notify the Income Tax Department promptly of any change in ownership.                                                 If receipt is desired, submit additional copy
                                                                                                                      and enclose self-addressed, stamped envelope.
Website: www.brunswick.oh.us/income-tax/
FORM EWR

                                                                                                                                    Return to Form                              Print Instructions/Worksheet

                                            INSTRUCTIONS FOR PREPARING AND FILING FORM EWR
MONTHLY – Employers must remit monthly if withholding in the                                                       Line 2 – Enter total ACTUAL tax withhold from employees during the 
previous calendar year exceeded $2,399, or if the total amount withheld                                            period for Brunswick Ohio city income tax.
in any month of the preceding calendar quarter exceeded $200. 
Payment shall be made not later than 15 days after the last day of each                                            Line 3 – Adjust current payment of actual tax withheld for 
month.                                                                                                             underpayment or overpayment in previous period. Specify and explain 
                                                                                                                   reason for adjustment on reverse side of original copy of this return.
QUARTERLY – Employers may remit quarterly if their withholdings 
are under the monthly thresholds and payment must be postmarked                                                    Line 4 – Late Payment Penalty Add 50% of the total tax due. Late File 
not later than the last day of the month following the last day of the                                             Penalty – $25 per month or fraction of a month with a maximum of 
calendar quarter.                                                                                                  $150.
*Note: Quarterly filers may use March, June, September, and December 
coupons with the due date of the last day of the month following the                                               Line 5 – See City website at www.brunswick.oh.us/income-tax for rates. 
last day of the quarter.                                                                                           (Interest is based on the Federal rate and may change annually.)

Line 1 – Enter total compensation paid all taxable employees during the                                            Line 6 – Enter sum total of the figures shown on lines 2, 3, 4 and 5 This is 
period for which return is made. If no compensation was paid during                                                the amount due and MUST be paid with this return.
period, so indicate and return form EWR.

                            Helpful	￿￿￿Information	￿￿￿for	￿￿￿Preparing	￿￿￿the	￿￿￿Monthly/Quarterly	￿￿￿Coupon	￿￿￿(Form	￿￿￿EWR)	￿￿￿
 WHO	￿￿￿MUST	￿￿￿FILE:	￿￿￿                                                                                          Failure	￿￿￿to	￿￿￿File	￿￿￿Return	￿￿￿and	￿￿￿Pay	￿￿￿Tax	￿￿￿
 Each	￿￿￿employer	￿￿￿located	￿￿￿within	￿￿￿or	￿￿￿doing	￿￿￿business	￿￿￿within	￿￿￿the	￿￿￿City	￿￿￿of	￿￿￿Brunswick,	￿￿￿ Any	￿￿￿individual,	￿￿￿firm	￿￿￿or	￿￿￿corporation	￿￿￿who	￿￿￿fails,	￿￿￿neglects	￿￿￿or	￿￿￿refuses	￿￿￿to	￿￿￿file	￿￿￿a	￿￿￿
 Ohio	￿￿￿who	￿￿￿employs	￿￿￿one	￿￿￿or	￿￿￿more	￿￿￿persons	￿￿￿is	￿￿￿required	￿￿￿to	￿￿￿withhold	￿￿￿Brunswick	￿￿￿       return,	￿￿￿who	￿￿￿refuses	￿￿￿to	￿￿￿pay	￿￿￿the	￿￿￿tax,	￿￿￿penalties	￿￿￿and	￿￿￿interest	￿￿￿imposed,	￿￿￿who	￿￿￿
 Income	￿￿￿Tax.	￿￿￿The	￿￿￿Brunswick	￿￿￿income	￿￿￿tax	￿￿￿of	￿￿￿2.0%	￿￿￿is	￿￿￿required	￿￿￿to	￿￿￿be	￿￿￿withheld	￿￿￿   refuses	￿￿￿to	￿￿￿permit	￿￿￿the	￿￿￿Tax	￿￿￿Administrator	￿￿￿or	￿￿￿any	￿￿￿duly	￿￿￿authorized	￿￿￿agent	￿￿￿or	￿￿￿
 from	￿￿￿Qualifying	￿￿￿Wages	￿￿￿paid	￿￿￿to	￿￿￿all	￿￿￿employees.	￿￿￿                                                employee	￿￿￿to	￿￿￿examine	￿￿￿his	￿￿￿books,	￿￿￿records	￿￿￿and	￿￿￿papers,	￿￿￿who	￿￿￿knowingly	￿￿￿makes	￿￿￿
 	￿￿￿                                                                                                              an	￿￿￿incomplete,	￿￿￿false	￿￿￿or	￿￿￿fraudulent	￿￿￿return,	￿￿￿or	￿￿￿who	￿￿￿attempts	￿￿￿to	￿￿￿do	￿￿￿anything	￿￿￿
 DEFINITION	￿￿￿OF	￿￿￿TAXABLE	￿￿￿EARNINGS:	￿￿￿                                                                      to	￿￿￿avoid	￿￿￿payment	￿￿￿of	￿￿￿the	￿￿￿whole	￿￿￿or	￿￿￿any	￿￿￿part	￿￿￿of	￿￿￿the	￿￿￿tax	￿￿￿shall	￿￿￿be	￿￿￿guilty	￿￿￿of	￿￿￿a	￿￿￿first	￿￿￿
 The	￿￿￿term	￿￿￿“Taxable	￿￿￿Earnings”	￿￿￿has	￿￿￿the	￿￿￿same	￿￿￿meaning	￿￿￿as	￿￿￿“Qualifying	￿￿￿Wages”	￿￿￿          degree	￿￿￿misdemeanor	￿￿￿and	￿￿￿shall	￿￿￿be	￿￿￿fined	￿￿￿not	￿￿￿more	￿￿￿than	￿￿￿$1,000	￿￿￿or	￿￿￿
 as	￿￿￿defined	￿￿￿in	￿￿￿ORC	￿￿￿718.03	￿￿￿(A).	￿￿￿For	￿￿￿most	￿￿￿employees	￿￿￿this	￿￿￿is	￿￿￿the	￿￿￿“Medicare	￿￿￿    imprisoned	￿￿￿for	￿￿￿not	￿￿￿more	￿￿￿than	￿￿￿6	￿￿￿months,	￿￿￿or	￿￿￿both,	￿￿￿for	￿￿￿each	￿￿￿offense.	￿￿￿The	￿￿￿
 Wage”	￿￿￿amount.	￿￿￿Medicare	￿￿￿Exempt	￿￿￿Employees	￿￿￿are	￿￿￿subject	￿￿￿to	￿￿￿the	￿￿￿same	￿￿￿                    failure	￿￿￿of	￿￿￿any	￿￿￿taxpayer	￿￿￿to	￿￿￿receive	￿￿￿or	￿￿￿procure	￿￿￿Form	￿￿￿EWR	￿￿￿is	￿￿￿not	￿￿￿reasonable	￿￿￿
 requirements	￿￿￿even	￿￿￿though	￿￿￿Box	￿￿￿5	￿￿￿of	￿￿￿the	￿￿￿W-￿￿2	￿￿￿is	￿￿￿blank.	￿￿￿                              cause	￿￿￿for	￿￿￿failing	￿￿￿to	￿￿￿make	￿￿￿payment	￿￿￿and	￿￿￿file	￿￿￿a	￿￿￿return,	￿￿￿or	￿￿￿relieve	￿￿￿you	￿￿￿of	￿￿￿your	￿￿￿
 Includes:	￿￿￿                                                                                                     obligations	￿￿￿to	￿￿￿file	￿￿￿in	￿￿￿a	￿￿￿timely	￿￿￿manner.	￿￿￿
      •        401(K),	￿￿￿457,	￿￿￿and	￿￿￿Supplemental	￿￿￿Unemployment	￿￿￿Compensation	￿￿￿
               Benefits	￿￿￿(SUB	￿￿￿pay)	￿￿￿                                                                        Any	￿￿￿check	￿￿￿in	￿￿￿payment	￿￿￿of	￿￿￿tax,	￿￿￿penalty	￿￿￿and/or	￿￿￿interest	￿￿￿which	￿￿￿is	￿￿￿returned	￿￿￿to	￿￿￿
      •        Nonqualified	￿￿￿Deferred	￿￿￿Compensation	￿￿￿Plans	￿￿￿                                               the	￿￿￿City	￿￿￿marked	￿￿￿insufficient	￿￿￿funds,	￿￿￿account	￿￿￿closed	￿￿￿or	￿￿￿stop	￿￿￿payment,	￿￿￿shall	￿￿￿
      •        Stock	￿￿￿Options	￿￿￿                                                                                be	￿￿￿subject	￿￿￿to	￿￿￿a	￿￿￿$30	￿￿￿charge	￿￿￿for	￿￿￿the	￿￿￿purpose	￿￿￿of	￿￿￿defraying	￿￿￿additional	￿￿￿
                                                                                                                   processing	￿￿￿expenses	￿￿￿incurred	￿￿￿by	￿￿￿the	￿￿￿city.	￿￿￿
 Does	￿￿￿NOT	￿￿￿include:	￿￿￿
      •        IRS	￿￿￿Section	￿￿￿125	￿￿￿wages	￿￿￿(Cafeteria	￿￿￿Plans)	￿￿￿                                          The	￿￿￿employer	￿￿￿is	￿￿￿responsible	￿￿￿for	￿￿￿payment	￿￿￿of	￿￿￿under-￿￿withholding.	￿￿￿

                            Withholding Tax Worksheet                                                                               Withholding Tax Worksheet
                  (Keep for your records – Do not file)                                                                       (Keep for your records – Do not file)
      Month    Due                                                                                                  Month     Due
      Ending  Date                  Check#                          Date              Amount                        Ending  Date    Check#                                      Date                       Amount

      1/31     2/15                 ________  ________                                ________                      7/31      8/15  ________                                    ________ ________

      2/28     3/15                 ________  ________                                ________                      8/31      9/15  ________                                    ________ ________

      3/31     4/15                 ________  ________                                ________                      9/30      10/15 ________                                    ________ ________

or 1st qtr     4/30                 ________  ________                                ________                     or 3rd qtr 10/31 ________                                    ________ ________

      4/30     5/15                 ________  ________                                ________                      10/31     11/15 ________                                    ________ ________

      5/31     6/15                 ________  ________                                ________                      11/30     12/15 ________                                    ________ ________

      6/30     7/15                 ________  ________                                ________                      12/31     1/15  ________                                    ________ ________

or 2nd qtr  7/31                    ________  ________                                ________                     or 4th qtr 1/31  ________                                    ________ ________