Form WTH-TAX — Withholding Tax Return

# WITHHOLDING TAX RETURN TAXPAYER ID TAX PERIOD BEGINNING TAX PERIOD ENDING

# RESET PRINT AMENDED DUE ON OR BEFORE

IMPORTANT: QUARTERLY FILERS MUST FILE EACH RETURN REGARDLESS
OF THE AMOUNT OF DELAWARE TAXES WITHHELD DURING THE PERIOD INDICATED.

NAME AND ADDRESS

1. DELAWARE INCOME TAX WITHHELD
2. AMOUNT REMITTED

If Line 2 does not equal Line 1, indicate the Tax Period End for which an adjustment is being made.
I declare under penalties of perjury that this is a true, correct, and complete return.

AUTHORIZED SIGNATURE DATE PHONE NUMBER
DF60021019999V1
Revision: 20210226 Page 1

EMAIL
MAIL COMPLETED FORM WITH
REMITTANCE PAYABLE TO:
Delaware Division of Revenue
PO Box 830
Wilmington, DE 19899-8330