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                                  DWQ-1 Employer’s Quarterly Return of City Tax Withheld 

                                                                     Tax Year                                  Quarter 

  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