CITY OF LEEDS
Reconciliation of Monthly Returns
Occupational Withholding Tax
1040 Park Drive
Leeds, AL 35094
PHONE - 205-699-2585 FAX - 205-699-6558
www.leedsalabama.gov
Period Covered
Total # of Employees
Recorded
Total Taxable Wages
for Employees
Total Occupational
Tax Withheld from
Employees' Wages
Total Tax Remitted
Difference Owed
(if any)
Month ended
January 31st
Month ended
February 28th
Month ended
March 31st
Month ended
April 30th
Month ended
May 31st
Month ended
June 30th
Month ended
July 31st
Month ended
August 31st
Month ended
September 30th
Month ended
October 31st
Month ended
November 30th
Month ended
December 31st
Total Tax Withheld
For Year
Business Name Account Number Year
NOTE: A copy of this form must be filled out on or before January 31st. Any discrepancy between the total amount withheld and the total amount remitted must be fully
explained in an attached statement. Please enclose payment for difference owed, if any.
Additional Amount Due (if any):
I declare, under penalties of perjury, that this return (and any accompanying schedules) has been examined by me and to the best of my
knowledge is true, correct and complete.
Signed: Date:
Telephone:Print Name:
W2 FORMS AND W3 FORM MUST BE ATTACHED
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