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Form W-3                                                                    WITHHOLDING TAX RECONCILIATION RETURN
CITY OF HUBBARD – INCOME TAX DEPARTMENT                                                         FOR TAX YEAR 2017               Please change tax year if necessary
   P.O. BOX 307, HUBBARD, OH 44425-0307
   VOICE (330) 534-6299 • FAX (330) 534-6282                                MUST BE RETURNED WITH W-2’S BY THE END OF FEBRUARY
                                                                        8. January...................$_________________     14. July.........................$_________________
1. Number of W-2’s attached..............$_________________             9. February.................$_________________      15. August....................$_________________
2. Number of employees working                                          10. March/Qtr. 1...........$_________________       16. September/Qtr. 3....$_________________
   in Hubbard at year end ....................$_________________        11. April........................$_________________ 17. October..................$_________________
3. Total payroll for the year..................$_________________       12. May.........................$_________________  18. November...............$_________________
4. Less payroll not subject to tax........$_________________            13. June/Qtr. 2..............$_________________     19. December/Qtr. 4.....$_________________
   Attach explanation                                                   20. Total remitted for year.............................................................................$ _________________
5. Payroll subject to tax.......................$_________________      21. Difference between Lines 6 & 20 (amount due/overpaid).......................$ _________________
6. Withholding tax liability at                                         Non-resident Employers                                  *Refunds are NOT automatically issued.
   1.5% of Line 5.................................$_________________    Do you withhold tax as a courtesy  Courtesy             If refund of overpayment is requested
7. Total Hubbard tax withheld                                           or because the employee(s) work(s)                      please attach explantation. If additional
   per W-2’s.........................................$_________________ in the City of Hubbard?            Works in Hubbard     tax is due, enclose payment with return.

EMPLOYER NAME/ADDRESS                                                       I hereby certify that the information and statements contained herein are
                                                                            true and correct.
                                FID#
                                                                            Signed By_________________________________________________________
                                Email
                                                                            Date______________________________________________________________
                                Phone
                                                                            Print Name ________________________________________________________
                                                                            Official Title________________________________________________________
                                                                                                           Owner, Partner, Member, President, Treasurer

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                          RECONCILIATION INSTRUCTIONS 

• The original of this reconciliation from must be filed with the HUBBARD CITY INCOME TAX 
  DEPARTMENT, P O Box 307, Hubbard, Ohio 44425-0307 on or before the last day of FEBRUARY, 
  unless a filing extension has been granted by the Hubbard City Income Tax Department.
• Copies of all W-2 forms applicable to the reconciliation must be attached.
• Also attached, should be a calculator tape or a schedule listing and totaling the amount of Hubbard 
  Ohio Income Tax withheld, as indicated by individual employee’s statements (W-2 form).
• Contact the Hubbard Tax Department for questions or assistance 330-534-6299.
• If the difference between lines 6 and 20 indicates a balance due, the amount should accompany 
  this return.
• If the difference is an overpayment, attach an explanation and indicate to credit the account for 
  the next year or the amount of refund requested.