2023 City of Mansfield, Ohio - Employer's Return of Tax Withheld - Quarterly

Quarter Ending:
Due (postmarked) last day of month after the end of calendar 
quarter

                                                                      Number of Full & Part Time Employees             FT PT
Please mail with remittance to:
City of Mansfield Income Tax Division - P.O. Box 577- Mansfield, Ohio 
44901                                                                 Total Wages subject to tax
Phone - 419-755-9711 
                                                                      Tax - 2.00% of total wages
Federal EIN:
                                                                      Late payment interest for 2023 .583%/month

                                                                      Late payment penalty is 50% of amount not timely 
                                                                      paid

                                                                      Late filing penalty $25/month each month late or 
                                                                      fraction thereof, for a maximum of $150.00

                                                                      Total

                                                                                                                            Date
                     Name and Address                                 Signature