CITY OF ONTARIO, OHIO                             EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
 Income Tax Rate:                                                                                              DOLLARS         CENTS I hereby certify that the information and statements
                                                                                                                                     contained herein are true and correct.
1.  Taxable Earnings paid all Employees subject to
 Ontario, Ohio City Income Tax........................................................... $                                          (Signed) ____________________________________________________
 Exclude under 18’s.
2.  Actual Tax Withheld this Quarter for City Income Tax........................ $
                                                                                                                                     (Title)_______________________________________________________
3.  Resident/Courtesy Withholding Tax................................................... $                                                                                               Date
4. Interest .............................................................................................. $                         (Phone) _____________________________________________________ 
5. Penalty............................................................................................... $                          THIS RETURN MUST BE FILED
                                                                                                                                     ON OR BEFORE THE DUE DATE SHOWN BELOW
6. TOTAL ............................................................................................... $
                                                                                                                                     MAKE CHECK OR MONEY ORDER PAYABLE TO
If no wages were paid this month, mark “NONE” and return this form with explanation.                                                 CITY OF ONTARIO, OHIO - INCOME TAX

Federal ID No.                                                                                               YEAR                    MAIL TO: CITY OF ONTARIO, OHIO
Name & Address                                                                                                                                INCOME TAX DEPT.
                                                                                                             1ST QUARTER                      555 STUMBO ROAD
                                                                                                                                              ONTARIO, OHIO 44906
                                                                                                             JAN, FEB, MAR
                                                                                                             DUE ON OR BEFORE
                                                                                                             APRIL 30
Notify Income Tax Division promptly of any change in ownership or name and address                                                   CHECK MUST ACCOMPANY FORM AND BE 
shown above.                                                                                                                         RECEIVED BY DUE DATE TO AVOID PENALTY.

CITY OF ONTARIO, OHIO                             EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
 Income Tax Rate:                                                                                              DOLLARS         CENTS I hereby certify that the information and statements
                                                                                                                                     contained herein are true and correct.
1.  Taxable Earnings paid all Employees subject to
 Ontario, Ohio City Income Tax........................................................... $                                          (Signed) ____________________________________________________
 Exclude under 18’s.
2.  Actual Tax Withheld this Quarter for City Income Tax........................ $
                                                                                                                                     (Title)_______________________________________________________
3.  Resident/Courtesy Withholding Tax................................................... $                                                                                               Date
4. Interest .............................................................................................. $                         (Phone) _____________________________________________________ 
5. Penalty............................................................................................... $                          THIS RETURN MUST BE FILED
                                                                                                                                     ON OR BEFORE THE DUE DATE SHOWN BELOW
6. TOTAL ............................................................................................... $
                                                                                                                                     MAKE CHECK OR MONEY ORDER PAYABLE TO
If no wages were paid this month, mark “NONE” and return this form with explanation.                                                 CITY OF ONTARIO, OHIO - INCOME TAX

Federal ID No.                                                                                               YEAR                    MAIL TO: CITY OF ONTARIO, OHIO
Name & Address                                                                                                                                INCOME TAX DEPT.
                                                                                                             2ND QUARTER                      555 STUMBO ROAD
                                                                                                                                              ONTARIO, OHIO 44906
                                                                                                             APR, MAY, JUN
                                                                                                             DUE ON OR BEFORE
                                                                                                             JULY 31
Notify Income Tax Division promptly of any change in ownership or name and address                                                   CHECK MUST ACCOMPANY FORM AND BE 
shown above.                                                                                                                         RECEIVED BY DUE DATE TO AVOID PENALTY.

CITY OF ONTARIO, OHIO                             EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
 Income Tax Rate:                                                                                              DOLLARS         CENTS I hereby certify that the information and statements
                                                                                                                                     contained herein are true and correct.
1.  Taxable Earnings paid all Employees subject to
 Ontario, Ohio City Income Tax........................................................... $                                          (Signed) ____________________________________________________
 Exclude under 18’s.
2.  Actual Tax Withheld this Quarter for City Income Tax........................ $
                                                                                                                                     (Title)_______________________________________________________
3.  Resident/Courtesy Withholding Tax................................................... $                                                                                               Date
4. Interest .............................................................................................. $                         (Phone) _____________________________________________________ 
5. Penalty............................................................................................... $                          THIS RETURN MUST BE FILED
                                                                                                                                     ON OR BEFORE THE DUE DATE SHOWN BELOW
6. TOTAL ............................................................................................... $
                                                                                                                                     MAKE CHECK OR MONEY ORDER PAYABLE TO
If no wages were paid this month, mark “NONE” and return this form with explanation.                                                 CITY OF ONTARIO, OHIO - INCOME TAX

Federal ID No.                                                                                               YEAR                    MAIL TO: CITY OF ONTARIO, OHIO
Name & Address                                                                                                                                INCOME TAX DEPT.
                                                                                                             3RD QUARTER                      555 STUMBO ROAD
                                                                                                                                              ONTARIO, OHIO 44906
                                                                                                             JUL, AUG, SEP
                                                                                                             DUE ON OR BEFORE
                                                                                                             OCTOBER 31
Notify Income Tax Division promptly of any change in ownership or name and address                                                   CHECK MUST ACCOMPANY FORM AND BE 
shown above.                                                                                                                         RECEIVED BY DUE DATE TO AVOID PENALTY.

CITY OF ONTARIO, OHIO                             EMPLOYER’S QUARTERLY RETURN OF TAX WITHHELD
 Income Tax Rate:                                                                                              DOLLARS         CENTS I hereby certify that the information and statements
                                                                                                                                     contained herein are true and correct.
1.  Taxable Earnings paid all Employees subject to
 Ontario, Ohio City Income Tax........................................................... $                                          (Signed) ____________________________________________________
 Exclude under 18’s.
2.  Actual Tax Withheld this Quarter for City Income Tax........................ $
                                                                                                                                     (Title)_______________________________________________________
3.  Resident/Courtesy Withholding Tax................................................... $                                                                                               Date
4. Interest .............................................................................................. $                         (Phone) _____________________________________________________ 
5. Penalty............................................................................................... $                          THIS RETURN MUST BE FILED
                                                                                                                                     ON OR BEFORE THE DUE DATE SHOWN BELOW
6. TOTAL ............................................................................................... $
                                                                                                                                     MAKE CHECK OR MONEY ORDER PAYABLE TO
If no wages were paid this month, mark “NONE” and return this form with explanation.                                                 CITY OF ONTARIO, OHIO - INCOME TAX

Federal ID No.                                                                                               YEAR                    MAIL TO: CITY OF ONTARIO, OHIO
Name & Address                                                                                                                                INCOME TAX DEPT.
                                                                                                             4TH QUARTER                      555 STUMBO ROAD
                                                                                                                                              ONTARIO, OHIO 44906
                                                                                                             OCT, NOV, DEC
                                                                                                             DUE ON OR BEFORE
                                                                                                             JANUARY 31
Notify Income Tax Division promptly of any change in ownership or name and address                                                   CHECK MUST ACCOMPANY FORM AND BE 
shown above.                                                                                                                         RECEIVED BY DUE DATE TO AVOID PENALTY.