City of Englewood
YEAR 20 _ _
DATE RECEIVED
Form W-3 SUBMIT BY FEBRUARY 28th . W-2 MUST BE ATTACHED
WITHHOLDING TAX RECONCILIATION
Account Number Federal ID Line 1 Number of W-2(s) attached
-W -
Line 2 Total Payroll for Year $
Name and Address of Business Line 3 Less Payroll not subject to Tax $
Line 4 Payroll Subject to Tax $
Line 5 Tax Due (Line 4 x 1.75%) $
January July
February August
March 1st Qtr September 3rd Qtr
April October
May November
MAKE CHECK/MONEY ORDER PAYABLE TO: MONTHLY/QUARTERLY PAYMENTS
CITY OF ENGLEWOOD June 2nd Qtr December 4th Qtr Year Total
Line 6 $
SUBMIT TO:
333 W NATIONAL RD Line 7 Balance Due
ENGLEWOOD TAX DEPARTMENT (Overpayment) $
ENGLEWOOD, OHIO 45322
tax@englewood.oh.us
I hereby certify that the information and statements contained are true and correct.
Signature ______________________________________ Title:_______________________ Date ____________
GENERAL INFORMATION
On or before February 28 of each year, each employer should be equal. If they are not equal, attach an explana-
must file a withholding reconciliation on Form W-3. Copies tion for any discrepancy.
of all W-2 forms applicable to the reconciliation must be
attached. All W-2(s) must furnish the name, address, so- If a balance due is indicated, the amount must be paid on
cial security number, qualifying wages, all the city taxes or before February 28th. If an overpayment is indicated,
that were withheld, along with the city names of which tax amended returns for the month(s) or quarter(s) in which
was withheld, and any other compensation paid to the indi- the overpayment occurred must be filed.
vidual.
The completed Form W-3 and all attachments must be
If copies of the W-2 forms are not available, each employer submitted to City of Englewood, Income Tax Department,
must provide a listing of the W-2 form. The listing must 333 W National Road, Englewood, Ohio, 45322, on or
contain the same information as required of the W-2 form. before February 28th of each year.
An adding machine tape, listing the amounts of income tax
withheld, as indicated by the individual employee’s state-
ments, should be included with the return. 333 W National Rd
Englewood, OH 45322
The Form W-3 must show a breakdown of all withholding
937-836-5106
payments made either quarterly or monthly in the boxes
provided. The amount paid and the amount withheld tax@englewood.oh.us