Form Br-941 - Employer'S Monthly Deposit Of Income Tax Withheld - State Of Michigan Page 4
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4BIG RAPIDS INCOME TAX DEPARTMENT
BR-941
BR-941
EMPLOYER’S MONTHLY DEPOSIT OF INCOME TAX WITHHELD
2009
941
10M
1. IDENTIFICATION NUMBER
2. DEPOSIT PERIOD
3. DUE ON OR BEFORE
4. WITHHOLDING TAX DEPOSIT
DO NOT
WRITE IN
OCTOBER 2009
11/30/2009
SPACE BELOW
TAXPAYER
MONTHLY DEPOSIT OF INCOME TAX IS
REQUIRED IF TAX WITHHELD IN FIRST
OR SECOND MONTH OF A QUARTER
EXCEEDS $100.
MAKE REMITTANCE PAYABLE TO:
___________________________________________
__________________________________________
_________________
BIG RAPIDS CITY TREASURER
SIGNATURE
TITLE
DATE
MAIL THIS FORM AND PAYMENT TO:
BIG RAPIDS TREASURER’S OFFICE
___________________________________________
__________________________________________
226 N. MICHIGAN AVENUE
PRINTED NAME OF SIGNER
TELEPHONE NUMBER
BIG RAPIDS, MI 49307
BIG RAPIDS INCOME TAX DEPARTMENT
BR-941
BR-941
EMPLOYER’S MONTHLY DEPOSIT OF INCOME TAX WITHHELD
2009
941
11M
1. IDENTIFICATION NUMBER
2. DEPOSIT PERIOD
3. DUE ON OR BEFORE
4. WITHHOLDING TAX DEPOSIT
DO NOT
WRITE IN
NOVEMBER 2009
12/31/2009
SPACE BELOW
MONTHLY DEPOSIT OF INCOME TAX IS
TAXPAYER
REQUIRED IF TAX WITHHELD IN FIRST
OR SECOND MONTH OF A QUARTER
EXCEEDS $100.
MAKE REMITTANCE PAYABLE TO:
___________________________________________
__________________________________________
_________________
BIG RAPIDS CITY TREASURER
SIGNATURE
TITLE
DATE
MAIL THIS FORM AND PAYMENT TO:
BIG RAPIDS TREASURER’S OFFICE
___________________________________________
__________________________________________
226 N. MICHIGAN AVENUE
PRINTED NAME OF SIGNER
TELEPHONE NUMBER
BIG RAPIDS, MI 49307
BIG RAPIDS INCOME TAX DEPARTMENT
BR-941
BR-941
EMPLOYER’S MONTHLY DEPOSIT OF INCOME TAX WITHHELD
2009
941
4Q
1. IDENTIFICATION NUMBER
2. DEPOSIT PERIOD
3. DUE ON OR BEFORE
DO NOT
DECEMBER
OR
WRITE IN
1/31/2010
TAX REMITTED
4
TH
QUARTER 2009
SPACE BELOW
TAXPAYER
October
November
December
Adjustments
_______________________________________
_______________________________________
___________________
SIGNATURE
TITLE
DATE
TOTAL
_______________________________________
PRINTED NAME OF SIGNER
PAY TO: BIG RAPIDS CITY TREASURER
MAIL TO: BIG RAPIDS TREASURER’S OFFICE
226 N. MICHIGAN AVENUE
_______________________________________
I I
If final return, check here and complete Notice
I I
TELEPHONE NUMBER
of Change or Discontinuance in return booklet.
BIG RAPIDS, MI 49307
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Form Br-941 - Big Rapids Income Tax Department Employer's Monthly Deposit Of Income Tax Withheld - State Of Michigan
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