Form 5121 - City Of Detroit Withholding Tax Schedule - 2016 Page 2
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1
22016 Form 5121, Page 2
Filer’s Full Social Security Number
City of Detroit Withholding Tax Schedule
NONRESIDENTS ONLY
PART 3: WAGE ALLOCATION FOR NONRESIDENTS
Part 3 applies only to Nonresidents computing wages earned in Detroit. Do not complete Part 3 if all of your work is performed in Detroit
because all wages are subject to tax. See instructions for additional information and definition of “days worked”.
Residents do not complete Part 3 because all wages are subject to tax.
A separate computation must be made for each W-2. If both filer and spouse have income subject to allocation, figure them separately.
Include only wages allocated to Detroit in column H below on Form 5119, line 9 or Form 5120, line 10, column B. If you need additional
space, attach a City of Detroit Withholding Tax Continuation Schedule (Form 5253).
F
G
H
A
B
C
D
E
Number of
Number of
Actual number
days paid
days vacation,
of days worked
Actual
Percentage of
Wages earned in Detroit.
(5 day week x
holidays, and
everywhere.
number of
days worked in
Total wages shown on W-2
Multiply G by percentage
52 weeks
other days not
Subtract
days worked in
Detroit.
(City Schedule W)
Enter “X” for:
C from B.
Detroit
Divide E by D.
(see instructions)
in F.
= 260 days)
worked.
Filer or Spouse
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
%
00
00
If column B is not 260 days, enter explanation.
NOTE: If your City of Detroit allocation is less than 100 percent, please obtain a letter from your employer to verify columns B through E
of Form 5121 and your work log. Treasury may request a copy of your work log and employer letter.
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0000 2016 104 02 27 7
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