Owner, Partner, Member, President, Treasurer
Form W3-1222
VILLAGE OF WALTON HILLS – INCOME TAX DEPARTMENT
7595 Walton Rd., Walton Hills, OH 44146
VOICE (440) 232-7800 • FAX (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
Please change tax year if necessary