2021 DELAWARE TAX RATE: 1.85%
CITY OF DELAWARE INCOME TAX
EMPLOYER’S RETURN OF TAX WITHHELD
I hereby certify that the information and statements
contained herein and in any schedules or exhibits
attached are true and correct.
Print Name: ____________________________________
Signed: ________________________________________
Official Title: ____________________________________
Date: __________________________________________
Make check or money order payable to
CITY OF DELAWARE INCOME TAX
Mail to
City of Delaware Income Tax
PO Box 496
Delaware OH 43015
740-203-1225
This return must be filed on or before the due date shown.
1. Tax withheld on income earned in Delaware
1.
2. Courtesy tax withheld at __________________% (reduced credit rate)
2.
3. Total tax withheld in period for Delaware.
3.
4. Adjustment of tax for prior period (explain on back)
4.
5.
Interest (.42% per month)
5.
6.
Penalty (50% of tax due)
6.
7. TOTAL (including interest and penalty if due)
7.
Delaware Tax ID: ______________ -W FIN: _____________________________
Company Name and Address: __________________________________________________
__________________________________________________
__________________________________________________
Company Email: _________________________________________ Phone Number: ___________________________
Period Ending DECEMBER 31, due on or before JANUARY 15
DEC
DEC
DEC
2021 DELAWARE TAX RATE: 1.85%
CITY OF DELAWARE INCOME TAX
EMPLOYER’S RETURN OF TAX WITHHELD
I hereby certify that the information and statements
contained herein and in any schedules or exhibits
attached are true and correct.
Print Name: ____________________________________
Signed: ________________________________________
Official Title: ____________________________________
Date: __________________________________________
Make check or money order payable to
CITY OF DELAWARE INCOME TAX
Mail to
City of Delaware Income Tax
PO Box 496
Delaware OH 43015
740-203-1225
This return must be filed on or before the due date shown.
1. Tax withheld on income earned in Delaware
1.
2. Courtesy tax withheld at __________________% (reduced credit rate)
2.
3. Total tax withheld in period for Delaware.
3.
4. Adjustment of tax for prior period (explain on back)
4.
5.
Interest (.42% per month)
5.
6.
Penalty (50% of tax due)
6.
7. TOTAL (including interest and penalty if due)
7.
Delaware Tax ID: ______________ -W FIN: _____________________________
Company Name and Address: __________________________________________________
__________________________________________________
__________________________________________________
Company Email: _________________________________________ Phone Number: ___________________________
Period Ending NOVEMBER 30, due on or before DECEMBER 15
NOV
NOV
NOV
2021 DELAWARE TAX RATE: 1.85%
CITY OF DELAWARE INCOME TAX
EMPLOYER’S RETURN OF TAX WITHHELD
I hereby certify that the information and statements
contained herein and in any schedules or exhibits
attached are true and correct.
Print Name: ____________________________________
Signed: ________________________________________
Official Title: ____________________________________
Date: __________________________________________
Make check or money order payable to
CITY OF DELAWARE INCOME TAX
Mail to
City of Delaware Income Tax
PO Box 496
Delaware OH 43015
740-203-1225
This return must be filed on or before the due date shown.
1. Tax withheld on income earned in Delaware
1.
2. Courtesy tax withheld at __________________% (reduced credit rate)
2.
3. Total tax withheld in period for Delaware.
3.
4. Adjustment of tax for prior period (explain on back)
4.
5.
Interest (.42% per month)
5.
6.
Penalty (50% of tax due)
6.
7. TOTAL (including interest and penalty if due)
7.
Delaware Tax ID: ______________ -W FIN: _____________________________
Company Name and Address: __________________________________________________
__________________________________________________
__________________________________________________
Company Email: _________________________________________ Phone Number: ___________________________
Period Ending OCTOBER 31, due on or before NOVEMBER 15
OCT
OCT
OCT
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