Form P-941 - Employer'S Return Of Income Tax Withheld - City Of Pontiac Income Tax Division - 2010 Page 2

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City of Pontiac
Income Tax Division
47450 Woodward Avenue
Pontiac, MI 48342
1. Last pay period on which Pontiac Taxes were
1. Last pay period on which Pontiac Taxes were
1. Last pay period on which Pontiac Taxes were
SUMM RY
withheld ___________________________
withheld ___________________________
withheld ___________________________
LIsT PAyMenTs MADe WITh P941
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
eMPLoyer’s reTurns.
applicable questions
applicable questions
applicable questions
n
n
n
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
JAnuAry
n
n
n
Business temporarily discontinued
Business temporarily discontinued
Business temporarily discontinued
FebruAry
Operations will be resumed on
Operations will be resumed on
Operations will be resumed on
MArCh
__________________________
__________________________
__________________________
(Date)
(Date)
(Date)
1sT quArTer ToTAL $
n
n
n
Still operating – Ceased paying wages
Still operating – Ceased paying wages
Still operating – Ceased paying wages
APrIL
Wages will be paid starting
Wages will be paid starting
Wages will be paid starting
MAy
__________________________
__________________________
__________________________
(Date)
(Date)
(Date)
June
n
n
n
Business sold to
Business sold to
Business sold to
2nD quArTer ToTAL $
Name _________________________
Name _________________________
Name _________________________
JuLy
Street _________________________
Street _________________________
Street _________________________
AugusT
City ___________________________
City ___________________________
City ___________________________
sePTeMber
State __________________________
State __________________________
State __________________________
3rD quArTer ToTAL $
Zip Code _______________________
Zip Code _______________________
Zip Code _______________________
oCTober
n
Moved out of Pontiac
n
Moved out of Pontiac
n
Moved out of Pontiac
noveMber
3. Your current address
3. Your current address
3. Your current address
DeCeMber
Street _________________________
Street _________________________
Street _________________________
4Th quArTer ToTAL $
City ___________________________
City ___________________________
City ___________________________
yeArLy ToTAL $
State __________________________
State __________________________
State __________________________
Zip Code _______________________
Zip Code _______________________
Zip Code _______________________
4.
n
Other: _________________________
4.
n
Other: _________________________
4.
n
Other: _________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________

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