Owner, Partner, Member, President, Treasurer
Form W3-1222
VILLAGE OF WALTON HILLS – INCOME TAX DEPARTMENT
7595 Walton Rd., Walton Hills, OH 44146
VOICE (440) 232-7800FAX (440) 232-4070
1. Number of W-2s attached ................ _________________
2. Number of employees working
in Walton Hills at year end ................ _________________
3. Total payroll for the year ..................$ _________________
4. Less payroll not subject to tax ........$ _________________
Attach explanation
5. Payroll subject to tax .......................$ _________________
6. Withholding tax liability at
2.5% of Line 5.................................$_________________
7. Total Walton Hills tax withheld
per W-2’s .........................................$_________________
January...................$
February .................$
March/Qtr. 1 ...........$
April ........................$
May.........................$
June/Qtr. 2..............$
Total remitted for year .............................................................................$
Difference between Lines 6 & 20 (amount due/overpaid) .......................$
8.
9.
10.
11.
12.
13.
20.
21.
July .........................$
August ....................$
September/Qtr. 3....$
October ..................$
November...............$
December/Qtr. 4.....$
14.
15.
16.
17.
18.
19.
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FEIN
I hereby certify that the information and statements contained herein are
true and correct.
Signed By _________________________________________________________
Date ______________________________________________________________
Print Name ________________________________________________________
Official Title________________________________________________________
Non-resident employers
Do you withhold tax as a courtesy
or because the employee(s) work(s)
in the Village of Walton Hills?
*Refunds are NOT automatically issued.
If refund of overpayment is requested
please attach explantation. If additional
tax is due, enclose payment with return.
Courtesy
Works in Walton Hills
EMPLOYER NAME/ADDRESS
Email
Phone
WITHHOLDING TAX RECONCILIATION
RETURN
FOR TAX YEAR
MUST BE RETURNED WITH W-2s BY THE END OF FEBRUARY
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2016
Please change tax year if necessary
View Instructions
RECONCILIATION INSTRUCTIONS
! An$annual$reconciliation$is$required$to$be$filed$with$copies$of$federal$Form$W32$by$the$last$day$of$February$
of$the$following$year.$All$W32s$must$furnish$the$name,$address,$social$security$number,$gross$wages,$an$
itemized$list in g$o f$the$amount$of$tax$withheld$that$specifies$each$municipality$and$the$amount$withheld$for$
it,$and$any $o th er$c o mpensation$p a id $to $th e $in d ivid u a l.$If$c o p ies $o f$th e $W32$forms$are$not$available,$each$
employer$must$provide$a$listing$of$all$employees$subject$to$Walton$Hills$tax.$The$listing$shall$req uire $the$
same$type$of$information$as$is$required$of$the$W32$forms$as$stated$above.$If$moving$expenses,$sick$pay,$
profit$sharing$and/or$deferred$compensation$are$included$in$gross$wages,$specify$amounts$separately.$
! 1099$submissions$–$Any$individual(s)$or$business$entity$compensating$individuals$on$a$commission$or$
contract$labor$basis$must$furnish$copies$of$the$1099$or$appropriate$earnings$statement$on$or$before$the$
last$day$of$F e b ru a ry$o f $ea ch $y e ar .$A ll$10 9 9 s$o r$e ar n in gs $sta tements$shall$require$the$same$type$of$
informat io n $as $is$re q u ire d$o f $th e$W32$forms$as$stated$above.$
! Magnetic/Electronic$Filing$–$Magnetic/electronic$reporting$is$preferred$and$must$comply$with$the$social$
security$administration$standards.$MMREF$or$EFW 2$form at$is$required.$Instructions$can$be$found$on$the$
Village$of$Walton$Hills$web$page:$www.waltonhillsohio.gov.$
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