Authorized Eft Signature Page For City Of Alibon Taxes Form

Authorized Eft Signature Page For City Of Alibon Taxes Form - 2005

ALBION 3121 (Rev. 11/05)

AUTHORIZED EFT SIGNATURE PAGE FOR CITY OF ALIBON TAXES

Issued under P.A. 284 of 1964, as amended.

This signature page must be submitted when a taxpayer is paying City of Albion taxes by electronic funds

transfer (EFT). Because no tax return is filed when paying by EFT, the signature on this form is

considered as if it actually appears on the electronically filed payment. This signature page must be

resubmitted when there is a change in the officer responsible for filing and paying City of Albion

withholding and corporate or partnership estimated payments of city income taxes.

Company Name

Federal Identification Number

Address (No. and Street or RR#)

City, State, Zip

Signature of officer responsible for reporting City of Albion withholding tax

Date

Type or Print Name

Title

Signature of officer responsible for paying City of Albion withholding tax (if different from above)

Date

Type or Print Name

Title

Signature of officer responsible for reporting City of Albion estimated income tax

Date

Type or Print Name

Title

Signature of officer responsible for paying City of Albion estimated income tax (if different from above)

Date

Type or Print Name

Title

Mail to:

City of Albion

Income Tax Division

If you have questions, please call:

112 West Cass Street

(517) 629-7865

Albion, MI 49224-0900

Authorized Eft Signature Page For City Of Alibon Taxes Form - 2005