EMPLOYER'S ANNUAL RECONCILIATION
OF SEBRING INCOME TAX WITHHELD
FOR CALENDAR YEAR 2002

 
COMPANY NAME:
 ____________________________________
ADDRESS:
 ____________________________________
FEDERAL I.D. NUMBER:
 ____________________________________
   

QUARTER ENDING

TAX REMITTED
3-31-2002
$ _____________________
6-30-2002
$ _____________________
9-30-2002
$ _____________________
12-31-2002
$ _____________________
TOTAL
$ _____________________

 

 
Number of W-2 forms enclosed:
_______________________________________
Roster of all employees enclosed (mandatory)
 _______________________________________
Date:
 _______________________________________
Name of preparer (print)
 _______________________________________
Signature of preparer:
 _______________________________________