EMPLOYERS RETURN OF TAX WITHHELD                                             PLEASE INDICATE WHICH PERIOD THIS RETURN IS FOR:
                               CITY OF SPRINGDALE                                                       JAN-MAR     20______ (DUE APR 30)
                               11700 SPRINGFIELD PIKE                                                   APR-JUN     20______ (DUE JUL 30)
                               SPRINGDALE, OH  45246                                                    JULY-SEP 20______    (DUE OCT 30)
                        PHONE (513) 346-5715   FAX (513) 346-5756                                       OCT-DEC     20______ (DUE JAN 30)
                                                                                                        OR
EMPLOYER'S SPRINGDALE ACCOUNT NUMBER                                                                    MONTH OF ____________________________
                                                                                                        (monthly withholding is due by the 15th of the following month)
EMPLOYER'S FEDERAL I.D. NUMBER                                                                       1. TAXABLE EARNINGS SUBJECT TO SPRINGDALE TAX     $_______________
                                                                                                     2. SPRINGDALE TAX            (2.0% OF LINE 1)     $_______________
EMPLOYER'S PHONE NUMBER                                                                                             OR
                                                                                                     3. EARNINGS SUBJECT TO SPRINGDALE COURTESY TAX    $_______________
EMPLOYER'S NAME AND ADDRESS                                                                          4. SPRINGDALE COURTESY TAX   (RATE____%OF LINE 3) $_______________
                                                                                                     5. ADJUSTMENTS                                    $
                                                                                                     6. TOTAL TAX PAID WITH THIS RETURN                $
                                                                                                     FOR OFFICE USE ONLY

                                                                                                     ______________________________________________       _________
W-1                                          YOU SHOULD FILE THIS RETURN EVEN IF THERE IS NO TAX DUE TAXPAYER SIGNATURE   (REQUIRED)                                      DATE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
                        EMPLOYERS RETURN OF TAX WITHHELD                                             PLEASE INDICATE WHICH PERIOD THIS RETURN IS FOR:
                               CITY OF SPRINGDALE                                                       JAN-MAR     20______ (DUE APR 30)
                               11700 SPRINGFIELD PIKE                                                   APR-JUN     20______ (DUE JUL 30)
                               SPRINGDALE, OH  45246                                                    JULY-SEP 20______    (DUE OCT 30)
                        PHONE (513) 346-5715   FAX (513) 346-5756                                       OCT-DEC     20______ (DUE JAN 30)
                                                                                                        OR
EMPLOYER'S SPRINGDALE ACCOUNT NUMBER                                                                    MONTH OF ____________________________
                                                                                                        (monthly withholding is due by the 15th of the following month)
EMPLOYER'S FEDERAL I.D. NUMBER                                                                       1. TAXABLE EARNINGS SUBJECT TO SPRINGDALE TAX     $_______________
                                                                                                     2. SPRINGDALE TAX            (2.0% OF LINE 1)     $_______________
EMPLOYER'S PHONE NUMBER                                                                                             OR
                                                                                                     3. EARNINGS SUBJECT TO SPRINGDALE COURTESY TAX    $_______________
EMPLOYER'S NAME AND ADDRESS                                                                          4. SPRINGDALE COURTESY TAX   (RATE____%OF LINE 3) $_______________
                                                                                                     5. ADJUSTMENTS                                    $
                                                                                                     6. TOTAL TAX PAID WITH THIS RETURN                $
                                                                                                     FOR OFFICE USE ONLY

                                                                                                     ______________________________________________       _________
W-1                                          YOU SHOULD FILE THIS RETURN EVEN IF THERE IS NO TAX DUE TAXPAYER SIGNATURE   (REQUIRED)                                      DATE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
                        EMPLOYERS RETURN OF TAX WITHHELD                                             PLEASE INDICATE WHICH PERIOD THIS RETURN IS FOR:
                               CITY OF SPRINGDALE                                                       JAN-MAR     20______ (DUE APR 30)
                               11700 SPRINGFIELD PIKE                                                   APR-JUN     20______ (DUE JUL 30)
                               SPRINGDALE, OH  45246                                                    JULY-SEP 20______    (DUE OCT 30)
                        PHONE (513) 346-5715   FAX (513) 346-5756                                       OCT-DEC     20______ (DUE JAN 30)
                                                                                                        OR
EMPLOYER'S SPRINGDALE ACCOUNT NUMBER                                                                    MONTH OF ____________________________
                                                                                                        (monthly withholding is due by the 15th of the following month)
EMPLOYER'S FEDERAL I.D. NUMBER                                                                       1. TAXABLE EARNINGS SUBJECT TO SPRINGDALE TAX     $_______________
                                                                                                     2. SPRINGDALE TAX            (2.0% OF LINE 1)     $_______________
EMPLOYER'S PHONE NUMBER                                                                                             OR
                                                                                                     3. EARNINGS SUBJECT TO SPRINGDALE COURTESY TAX    $_______________
EMPLOYER'S NAME AND ADDRESS                                                                          4. SPRINGDALE COURTESY TAX   (RATE____%OF LINE 3) $_______________
                                                                                                     5. ADJUSTMENTS                                    $
                                                                                                     6. TOTAL TAX PAID WITH THIS RETURN                $
                                                                                                     FOR OFFICE USE ONLY

                                                                                                     ______________________________________________       _________
W-1                                          YOU SHOULD FILE THIS RETURN EVEN IF THERE IS NO TAX DUE TAXPAYER SIGNATURE   (REQUIRED)                                      DATE