City of Englewood 
Income Tax Department 
333 W National Rd 
Englewood, OH  45322 
Phone:  937-836-5106                         City of Englewood 
Fax: 937-771-2891 
Email:  tax@englewood.oh.us 
www.englewood.oh.us 
                                                         Tax Year ________ 
                                                                                                                               Form W-1 

EMPLOYER’S RETURN OF TAX WITHHELD 

     Account Number               Federal ID             Courtesy Withholding Withholding Period                      Due Date 
                                                         Final Return 

                            Name and Address of Business                      1.  Payroll this Period        $ 
                                                                              2.  Tax Withheld - 1.75%       $ 

                                                                              3.  Adjustment to Prior Period $ 

                                                                              4.  Late Fee    $25.00         $ 

                                                                              5.  TOTAL DUE                  $ 

                                                                              MAKE CHECK OR MONEY ORDER PAYABLE TO: 

Signature ______________________________________    Date:_____________        CITY OF ENGLEWOOD 

Notify the Department of Taxation promptly of any change in ownership.                                       MAIL TO: 

     AMENDED (attach explanation)                                             ENGLEWOOD TAX DEPARTMENT 
                                                                                            333 W NATIONAL RD 
                                                                              ENGLEWOOD, OHIO  45322 

                                               GENERAL INFORMATION 

Each employer within or doing business within the City         Delinquent payments shall be subject to penalty, interest and late filing 
of Englewood who employs one or more persons is                fee  charges  as  provided  for  in  the  Tax  Ordinance.   Postage  meter 
required  to  withhold  the  tax  from  all  qualifying  wages dates  are  not  recognized  as  a  verification  of  timely  filing  for 
paid to employees at the time the compensation is paid,        monthly contributors. 
and file Form W-1 and remit the tax to:                         
          Englewood Tax Department                             The failure of any employer to receive or procure Form W-1 shall not 
          333 W National Road                                  excuse him/her from filing this return or from remitting the tax withheld.
        Englewood, Ohio  45322                                   
 
Most employers are monthly withholders; unless your            Line 1 -   Enter  total  qualifying  wages  paid  to  all  taxable  employees 
preceding calendar year did not exceed $2,399                    during the period for which return is being filed.  If no  
in  withholding  or  in  the preceding  calendar quarter for     compensation  was  paid  during  the  period,  so  indicate  and 
any month of the quarter the withholdings did not                return Form W-1. 
exceed $200.                                                   Line 2 -  Compute Tax due - 1.75% of Line 1 
 
MONTHLY:  All returns and payments are due on or               Line 3 -  Show any adjustments to tax due; e.g. additional tax 
before  the  15th  day  following  the  of  month  for  the      withheld at employee request, 2nd city payment, etc. 
amount withheld during the preceding month.                    Line 4 -  Late Filing Fee is $25.00 per 30 days late 
 
QUARTERLY:   All returns and payments are due on               Line 5 -  Enter amount remitted. 
or before the 30th day following the end of the quarter 
for the amount withheld during the preceding quarter. 
 
SEMI MONTHLY:  At this time the City of Englewood 
will not be enforcing the semi monthly withholding  
status.