State of Rhode Island Division of Taxation 
      Form RI-W3 
                                                              19106199990101
      Transmittal of Wage and Tax Statements

 Name                                                         Federal employer identification number

 Address                                                      For the calendar year ending:
                                                                                                           12312023
 Address 2                                                    E-mail address

 City, town or post office    State ZIP code
                                                                                       Amended Return

 1a Total tax withheld for the 1st Quarter (January, February, and March) as shown on Form RI-941.............................                                         1a

 b Total tax withheld for the 2nd Quarter (April, May, and June) as shown on Form RI-941.........................................                                      1b

 c Total tax withheld for the 3rd Quarter (July, August, and September) as shown on Form RI-941.............................                                           1c

 d Total tax withheld for the 4th Quarter (October, November, and December) as shown on Form RI-941 ..................                                                 1d

 e Total tax withheld for the year. Add lines 1a through 1d.......................................................................................                     1e

 2 Total payments made for the year .................................................................................................................................. 2

 3 Amount Due. Subtract line 2 from line 1e.............................................................................................................               3

 4 Total amount of state wages, tips, and other compensation for the calendar year ..............................................                                      4

 5 Total number of state wage & tax statements (Form W2) sent with this reconciliation form................................                                            5

Note:   
If you are an employer with 25 or more employees, it is required that all of the W-2 forms issued to employ-
ees are submitted electronically to the RI Division of Taxation through electronic file transfer (EFT) or on CD.   
 
For more information and to set up secure FTP, please send an email to Tax.ProdControl@tax.ri.gov.  

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
 belief, it is true, accurate and complete.  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
 Authorized officer signature Print name                                   Date                                                                                          Telephone number

 Paid preparer signature      Print name                                   Date                                                                                          Telephone number

 Paid preparer address        City, town or post office State           ZIP Code                                                                                                     PTIN

                              May the Division of Taxation contact your preparer?   YES

                              Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908                                                                                    Revised 
                                                                                                                                                                                         08/2023