FORM W-3 ~ MANTUA VILLAGE TAX RECONCILIATION ~ 2007

Employer's Name, address, and FEIN number File with:

Village of Mantua
Income Tax Dept.
4650 W. High St.
Mantua, Ohio 44255

INSTRUCTIONS

If item 7 indicates overpayment and refund is desired, attach explanation. If additional tax due is indicated, enclose payment when filing.

The tax ordinance requires the annual preparation and filing of this report, from all employers subject to the tax, on or before January 31, 2008.

Other information required to be submitted with this report is the name and address of each employee completely, or only in part, subject to tax during the tax year, the total gross earnings of each such employee and the amount of tax withheld from those earnings. If additional space is required, continue on reverse side, or attach additional sheets. Employers desiring to submit commercially reproduced copies of federal W-2 or electronic reproductions bearing the required information in either card or listing form may do so in lieu of the listing form.

  1. Total Number of Employees

  2. Total Payroll of the Year

  3. Less Payroll Not Subject to Tax

  4. Payroll Subject to Tax

  5. Withholding Tax Liability,
    1 1/2% of Line 4
_____________________

$ ____________________

$ ____________________

$ ____________________

$ ____________________

TOTAL MANTUA INCOME TAX

First Quarter (3/31)
Second Quarter (6/30)
Third Quarter (9/30)
Fourth Quarter (12/31)

6. Total Remitted for Year

7. Overpayment OR

8. Additional Tax Due

WITHHELD AND REMITTED

$ ____________________
$ ____________________
$ ____________________
$ ____________________

$ ____________________

$ ____________________

$ ____________________


LIST OF EMPLOYEES
Names and Addresses 		AMOUNT OF TOTAL GROSS EARNINGS AMOUNT OF VILLAGE TAX WITHHELD
. . .