ANNUAL RECONCILIATION

ANNUAL RECONCILIATION
NAME

First NameLast Name
COMPANY NAME
Email
example@example.com
COMPANY ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer’s Annual Reconciliation of Taxes Withheld and Quarterly Payments Shown by Employer’s Quarterly Returns of License Fess Withheld (SMW-1)
1. QUARTER ENDED MARCH 31:
2. QUARTER ENDED JUNE 30:
3. QUARTER ENDED SEPTEMBER 30:
4. QUARTER ENDED DECEMBER 31:
5. TOTAL REMITTED FOR YEAR:
FOR CALENDAR YEAR
DUE ON/BEFORE
ACCOUNT NUMBER (If known)
6. TOTAL TAX REMITTED ON QUARTERLY RETURNS:
7. TOTAL TAX WITHHELD PER EMPLOYEE STATEMENTS ATTACHED:
ANY DISCREPANCY BETWEEN THE AMOUNTS SHOWN ON LINES 6 & 7 MUST BE FULLY EXPLAINED IN AN ATTACHED STATEMENT
DISCREPANCY STATEMENT UPLOAD

Cancelof
ATTACH A LIST OF EMPLOYEES’ NAMES, ADDRESSES, SOCIAL SECURITY NUMBERS, GROSS PAY, AND THE AMOUNT SUBJECT TO ST. MATTHEWS EMPLOYEE WITHOLDING TAX, AND TAX DEDUCTED AND PAID TO ST. MATTHEWS.
LIST OF EMPLOYEES UPLOAD

Cancelof
NOTIFY CITY OF ANY CHANGE IN OWNERSHIP, NAME, OR ADDRESS
1. QUARTER ENDED MARCH 31:
2. QUARTER ENDED JUNE 30:
3. QUARTER ENDED SEPTEMBER 30:
4. QUARTER ENDED DECEMBER 31:
5. TOTAL REMITTED FOR YEAR:
FOR CALENDAR YEAR
DUE ON/BEFORE
ACCOUNT NUMBER (If known)
6. TOTAL TAX REMITTED ON QUARTERLY RETURNS:
7. TOTAL TAX WITHHELD PER EMPLOYEE STATEMENTS ATTACHED:
Should be Empty: