WITH HOLDING TAX RECONCILIATION

Total number of employees as represented by
Forms W-2 submited herewith ____________

Total Income Tax Withheld from compensation
Paid all employees $____________________

LEGIBLE COPIES OF W-2 FORMS MUST ACCOPANY THIS FORM BY:

TAXES WITHHELD AND REMITTANCES MADE

Quarters Withheld		Amount Withheld
1^st Quarter .....................		$________________
2^nd Quarter ....................		$________________
3^rd Quarter .....................		$________________
4^th Quarter .....................		$________________
TOTAL AMOUNT WITHHELD..............		$________________
TOTAL REMITTANCES MADE............		$________________
DIFFERANCE ( IF ANY ).......................		$________________
Explain fully any discrepancy.