Reconciliation of Brownsville Payroll Tax Withheld

Report the city payroll tax withheld during the year ended, list the employees, and submit for review by the city team.

Employer — Principal Place of Business

Business Type *

Employer Name

Federal Identification Number (EIN)

Enter the employer EIN manually.

Address *

Address Line 2 (optional)

City *

State *

ZIP *

Reconciliation Summary — During Year Ended

Year *

Total Number of Employees Listed *

Quarter ended Mar. 31 ($)

Quarter ended June 30 ($)

Quarter ended Sept. 30 ($)

Quarter ended Dec. 31 ($)

Total Remitted for Year ($) *

Employees

Social Security No. *	Name of Employee *	Gross Wages Paid ($) *	City Payroll Tax Withheld ($) *

Totals		$0.00	$0.00

If the report is not complete on this page, the city team will reconcile additional pages provided separately.

Contact Information

First Name *

Last Name *

Email Address *

A 6-digit verification code will be emailed if your address is not on file.

Signature & Consent

Sign below *

Use your mouse or finger to sign in the box above.

Printed name *

Consent statement

Additional Notes (optional)

I confirm this submission is accurate and I am authorized to file on behalf of this business.

Questions? Contact city support.