City of Wooster, Ohio

Employer's Return of Tax Withheld

Filing requirements:
Monthly filing and payment is required if an employer withheld $2,399 in the immediate preceding calendar year, or more than 
$200.00 in any one month of the immediate calendar year. The due date for monthly withholding is the 15th day of the 
following month. Quarterly filing and payment is required if an employer withheld $2,399 or less in the immediately preceding 
calendar year, or $200.00 or less for each month in the immediate calendar quarter. The due date for quarterly filing is the last 
day of the following month. 

Interest and Penalties:

Any money withheld, or required to be withheld, and remaining unpaid after it has become due will be subject to penalty 

and interest. Interest shall be calculated at the rate of .583% per month, and penalty at the rate of 50%. 

Questions, please call 330-263-5226
                                                                                            Withholder's Copy
How to Prepare this Form:                                          Fed ID/File #            Due on or Before           Period Ending
Line 1: Enter total compensation subject to Wooster
tax during the period indicated. If no compensation             1. Wages Subject to Wooster Tax    
was paid, enter zero (-0-) and attach explanation.              2. Wooster Tax Withheld 1.5%
Line 2: Enter total actual tax withheld during the              3. Adjustments
period indicated. If this amount is not 1.5% of line 1,         4. Interest (.   583% per month) 
attach explanation.                                             5. Penalty (50%)
Line 3: Enter adjustment and attach explanation.                6. Total Enclosed
Line 4: .583% per month or fraction thereof.
Line 5: 50%
Line 6:Enter the total of tax (line 2), adjustments (line 3), i nterest (line 4) 
and penalty (line 5).
        Retain top portion for your records. Complete and return the bottom portion with remittance to:
                                 City of Wooster, PO BOX 1088, Wooster, OH 44691-7081
                                                                DETACH HERE
                                 City of Wooster, Ohio- Return of Tax Withheld
    Fed ID/ File #        Due on or Before                     For Period Ending 1. Taxable Wages
                                                                                 2. Wooster Tax Withheld 1.5%
            Checks Payable: City of Wooster- Income Tax                          3. Adjustments
Name & Address:                                                                  4. Interest
                                                                                 5. Penalty
                                                                                 6. Total enclosed

                                                                                 I hereby certify that the information and statements 
                                                                                 contained herein are true and correct.

                                                                                 Signature:
                                                                                 Print Name:
                                                                                 Title: