RECONCILLIATION FORM
FOR INCOME TAX WITHHELD
SOUTH BLOOMFIELD INCOME TAX DEPARTMENT
PHONE (740)983-2541 FAX: (740)983-4531
Total Wages subject
to income tax
..$_______________
Total Wages withheld
for tax year 200___..................................$_______________
Company Name &
Address:
Signature______________________
Date____________________________W2s
MUST be sent along with your final reconciliation.