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Employer's Return of Virginia Income Tax Withheld Instructions

General: Anemployerwhopayswagestooneormoreemployeesisrequired to deduct and withhold state income tax from those wages. Virginia law substantiallyconformstothefederaldefinitionof"wages."Therefore,Virginia withholdingisgenerallyrequiredonanypaymentforwhichfederalwithholding isrequired,exceptamountspaidpursuanttoindividualretirementaccounts andsimplifiedemployeepensionplansasdefinedinSections7701(a)(37) and408(c)oftheInternalRevenueCode. Filing and Payment Procedure:Anemployer'sfilingstatusisdetermined bytheaverageamountofincometaxwithheldeachmonth.Whenregistering abusiness,anemployerisaskedtoestimatethisfiguresotheDepartment canassignafilingstatus.Basedonthatinformation,theDepartmentassigns aquarterly,monthly,semi-weekly,orseasonalfilingstatus.Inaddition,all employersmustfileanannualsummary.Employersarenotresponsiblefor monitoringtheirmonthlytaxliabilitiestoseeifastatuschangeisneeded. TheDepartmentreviewseachaccountannuallyandmakesanynecessary changes. Notices of change in filing status are usually mailed during DecemberofeachyearandbecomeeffectiveonJanuary1. PaymentsmaybemadebycheckorbyElectronicFundsTransfer(EFT). Paymentsreturnedbythebankwillbesubjecttoareturnedpaymentfeein additiontoanyotherpenaltiesthatmaybeincurred. PayingbyEFTeliminatesyourrequirementtosubmitFormVA-5,however paymentsmustbemadebythesamedatesthattheFormVA-5wouldhave beendue.Whennopaymentisduebecausethetaxliabilityiszero,youmust reportaZEROliabilitytotheDepartment.Thiscanbedonebyreportinga zeropaymentonyourEFTtransaction.Foradditionalinformationregarding EFT,pleaserefertotheDepartment'sElectronic Funds Transfer (EFT) Guide. AGuidemaybeobtainedfromtheDepartment'swebsite,www.tax.virginia. gov, orFormsRequestUnitat(804)440-2541. · Quarterly Filing: If an employer's average monthly withholding tax liabilityislessthan$100,theaccountwillbeassignedaquarterlyfiling status.FormVA-5,withfullpaymentforthetax,oryourEFTpayment isdueonthelastdayofthemonthfollowingthecloseofthequarter. A return or EFT zero transaction payment must be filed for each quarter even if there is no tax due. · MonthlyFiling:Iftheaveragemonthlywithholdingtaxliabilityisatleast $100,butlessthan$1,000,amonthlyfilingstatuswillbeassigned. FileFormVA-5ormakeyourEFTpaymentbythe25thdayofthe followingmonth.A return or EFT zero transaction payment must be filed for each month, even if there is no tax due. · SeasonalFiling: Seasonalfilers,thoseemployerswhohaveemployees onlyduringcertainmonthsoftheyear,arerequiredtofilereturnsfor themonthsdesignatedatthetimetheyregisterforanaccount,even ifthereisnotaxdue.SeasonalreturnsarefiledonFormVA-5and aredueatthenormalmonthlyfilingdates. MailquarterlyreturnsandpaymentstotheVirginia Department of Taxation, P.O. Box 26644, Richmond, Virginia 23261-6644. Mailmonthly and seasonalreturnsandpaymentstotheVirginia Department of Taxation, P.O. Box 27264, Richmond, Virginia 23261-7264. Change of Ownership: Iftherehasbeenachangeofownership, donotusethereturnwiththenameandaccountnumberofthe formerowner.SendthereturnwithnoticeofchangetotheVirginia Department of Taxation, P.O. Box 1114, Richmond, Virginia 23218-1114.Youcanregisteranewdealerand/orlocations,by eithercompletingaFormR-1,BusinessRegistrationApplication,or electronicallyusingiRegontheDepartment'swebsite,www.tax. virginia.gov.TheFormR-1canbeobtainedfromtheDepartment's web site or by calling the Department's Forms Request Unit at (804)440-2541. Change of Address/Out-of-Business: If you change your businessmailingaddressordiscontinueyourbusiness,eithersend acompletedFormR-3,RegistrationChangeRequestoraletterto theVirginia Department of Taxation, P.O. Box 1114, Richmond, Virginia 23218-1114.TheFormR-3isincludedinyourcoupon booklet.AFormR-3canalsobeobtainedfromtheDepartment's website,www.tax.virginia.gov,orbycallingtheDepartment's FormsRequestUnitat(804)440-2541. Questions:Ifyouhaveanyquestionsaboutthisreturn,please call(804)367-8037orwritetheVirginia Department of Taxation, P.O. Box 1115, Richmond, Virginia 23218-1115. Preparation of Return Line 1: Enter amount of income tax withholding liability for the periodforwhichthereturnisbeingfiled. Line 2: Enteroverpaymentorunderpaymentfromapriorperiod andattachadetailedexplanation tothereturn.Please indicate an underpayment as a negative figure with bracketsaroundtheamount. Line 3: Subtract overpayment (Line 2) from Line 1 or add underpayment(Line2)toLine1andentertheamount. (Line15Line2=Line3). Line 4: Enterpenalty,ifapplicable.Ifyoufilethereturnand/or paythetaxaftertheduedate,apenaltyisassessed.The penaltyis6%ofthetaxdueforeachmonthorfractionof amonth,nottoexceed30%.Innocasewillthepenalty belessthan$10,even if no tax is due. Line 5: Enterinterest,ifapplicable.Interestonanytaxduewillbe addedatthedailyinterestrateestablishedinaccordance withSection58.1-15oftheCode of Virginiafromthedate the unpaid tax (or unpaid balance) became dueuntilit ispaid.Theinterestrateis2%overtheunderpayment rateestablishedbySection6621oftheInternalRevenue Code. Line 6: EnterthetotalofLines3,4and5. Declaration and Signature: Be sure to sign, date and enter yourphonenumberonthereversesideofthereturninthespace indicated.

Detach at dotted line below. DO NOT SEND ENTIRE PAGE.

Form VA-5

PERIOD

(Doc ID 355) Q For assistance, call (804)367-8037.

Employer's Return of Virginia Income Tax Withheld

1. VAIncomeTax Withheld 2. PreviousPeriod(s) Adjustments (SeeInstructions) 3. AdjustmentTotal

DUEDATE

0000000000000000 3558888 00000

ACCTNO. NAME ADDRESS CITY STATE ZIP FEIN

Ideclarethatthisreturn(includingaccompanyingschedulesandstatements)hasbeenexamined bymeandtothebestofmyknowledgeandbeliefistrue,correctandcomplete. Signature Va.Dept.ofTaxationVA-5ARWREV7/07 Date PhoneNumber

Q

4. Penalty (SeeInstructions) 5. Interest (SeeInstructions)

6. TotalAmountDue

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