Form 5121 - City Of Detroit Withholding Tax Schedule - 2016
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City Schedule W
Michigan Department of Treasury - City Tax Administration
5121 (05-16)
City of Detroit Withholding Tax Schedule - 2016
Issued under authority of Public Act 284 of 1964, as amended.
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0123456789
Type or print in blue or black ink. Print numbers like this:
- NOT like this:
INSTRUCTIONS:
If you had city income tax withheld in 2016, you must complete a Withholding Tax Schedule (City Schedule W) to claim the
withholding on your City Income Tax Return. Do not attach your Forms W-2. Attach your completed City Schedule W to Form 5118, Form 5119,
or Form 5120. If you need additional space, complete the City of Detroit Withholding Tax Continuation Schedule (Form 5253).
1. Filer’s First Name
M.I.
Last Name
2. Filer’s Full Social Security No. (Example: 123-45-6789)
If a Joint Return, Spouse’s First Name
M.I.
Last Name
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
4. Return for the city of:
City Code
DETROIT
170
PART 1: CITY TAX WITHHELD
D —
E
A
B —
C
Wages, tips and other
Employer’s federal
compensation from
City income tax withheld
identification number
Enter “X” for:
Box 1 of W-2 (see instructions)
from Box 19 of W-2
(Example: 38-1234567)
Employer’s name
Filer or Spouse
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
5. Total City Tax Withheld. Enter here and carry to Form 5118, line 17, Form 5119, line 20 or Form 5120, line 36.
00
PART 2: CITY TAX PAID FOR YOU BY A PARTNERSHIP
A
B
C
Name of Partnership
Federal Identification Number
Tax Paid
00
00
00
6. Total. Enter here and carry to Form 5118, line 19, Form 5119, line 22 or Form 5120, line 38. ................
00
Check this box and complete the City of Detroit Withholding Tax Continuation Schedule (Form 5253) if you
have more than eight W-2s to report or had tax paid on your behalf by more than three partnerships.
NOTE:
•
All wage income earned by residents is subject to tax. Residents should not complete Part 3 on page 2.
•
Nonresidents who performed work both within and outside the city listed on line 4 should complete Part 3 on page 2.
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