PRINTED NAME OF SIGNER
complete Notice of Change or
Discontinuance in return booklet.
GR-501
GRAND RAPIDS INCOME TAX DEPARTMENT
GR-501
EMPLOYER'S MONTHLY DEPOSIT OF INCOME TAX WITHHELD
2004
941
04M
4. WITHHOLDING TAX DEPOSIT
DO NOT
1. IDENTIFICATION NUMBER
2. DEPOSIT PERIOD
3. DUE ON OR BEFORE
WRITE IN
APRIL 2004
5/31/2004
SPACE BELOW
MONTHLY DEPOSIT OF INCOME TAX
TAXPAYER
IS REQUIRED IF TAX WITHHELD IN FIRST
OR SECOND MONTH OF A QUARTER
EXCEEDS $100.
IMPORTANT
MONTH
YEAR
5.
IF DEPOSIT IS FOR A
PERIOD OTHER THAN
BOX 2, ENTER THE
CORRECT PERIOD.
MAKE REMITTANCE PAYABLE TO:
GRAND RAPIDS CITY TREASURER
MAIL THIS FORM AND PAYMENT TO:
SIGNATURE
TITLE
DATE
GRAND RAPIDS INCOME TAX DEPT.
P.O. BOX 347
PRINTED NAME OF SIGNER
GRAND RAPIDS, MI 49501-0347
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
CUT ON DOTTED LINE
GRAND RAPIDS INCOME TAX DEPARTMENT
GR-501
GR-501
EMPLOYER'S MONTHLY DEPOSIT OF INCOME TAX WITHHELD
2004
941
05M
DO NOT
4. WITHHOLDING TAX DEPOSIT
1. IDENTIFICATION NUMBER
2. DEPOSIT PERIOD
3. DUE ON OR BEFORE
WRITE IN
MAY 2004
6/30/2004
SPACE BELOW
MONTHLY DEPOSIT OF INCOME TAX
TAXPAYER
IS REQUIRED IF TAX WITHHELD IN FIRST
OR SECOND MONTH OF A QUARTER
EXCEEDS $100.
IMPORTANT
MONTH
YEAR
5.
IF DEPOSIT IS FOR A
PERIOD OTHER THAN
BOX 2, ENTER THE
CORRECT PERIOD.
MAKE REMITTANCE PAYABLE TO:
GRAND RAPIDS CITY TREASURER
MAIL THIS FORM AND PAYMENT TO:
SIGNATURE
TITLE
DATE
GRAND RAPIDS INCOME TAX DEPT.
P.O. BOX 347
PRINTED NAME OF SIGNER
GRAND RAPIDS, MI 49501-0347
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
CUT ON DOTTED LINE
GRAND RAPIDS INCOME TAX DEPARTMENT
GR-941
GR-941
EMPLOYER'S QUARTERLY RETURN OF INCOME TAX WITHHELD
2004
941
02Q
DO NOT
4. TAX WITHHELD THIS QUARTER
1. IDENTIFICATION NUMBER
2. RETURN PERIOD
3. DUE ON OR BEFORE
WRITE IN
ND
8/02/2004
2
QUARTER 2004
SPACE BELOW
5. ADJUSTMENTS
TAXPAYER
6. ADJUSTED TAX WITHHELD
7a. TAX PAID FIRST
MONTH OF QUARTER
7b. TAX PAID SECOND
MONTH OF QUARTER
8. AMOUNT DUE
(Line 6 less lines 7a and 7b)
PAY THIS AMOUNT
SIGNATURE
TITLE
DATE
PAY TO:
GRAND RAPIDS CITY TREASURER