Form H941-501 - Hamtramck Income Tax Withheld

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HAMTRAMCK INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF HAMTRAMCK
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
H941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE
1
AMOUNT WITHHELD
3401 EVALINE
1
1ST MONTH THIS QTR
HAMTRAMCK, MICHIGAN 48212
SIGNATURE
2
AMOUNT WITHHELD
VALIDATION AREA BELOW
2ND MONTH THIS QTR
TITLE
DATE
3
AMOUNT WITHHELD
3RD MONTH THIS QTR
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
WITHHELD
PERIOD
DUE ON
IDENTIFICATION NO.
7
AMOUNT
DUE
HAMTRAMCK INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF HAMTRAMCK
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
H941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE
1
AMOUNT WITHHELD
3401 EVALINE
2
1ST MONTH THIS QTR
HAMTRAMCK, MICHIGAN 48212
SIGNATURE
2
AMOUNT WITHHELD
VALIDATION AREA BELOW
2ND MONTH THIS QTR
TITLE
DATE
3
AMOUNT WITHHELD
3RD MONTH THIS QTR
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
WITHHELD
PERIOD
DUE ON
IDENTIFICATION NO.
7
AMOUNT
DUE
HAMTRAMCK INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF HAMTRAMCK
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
H941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE
1
AMOUNT WITHHELD
3401 EVALINE
3
1ST MONTH THIS QTR
HAMTRAMCK, MICHIGAN 48212
SIGNATURE
2
AMOUNT WITHHELD
VALIDATION AREA BELOW
2ND MONTH THIS QTR
TITLE
DATE
3
AMOUNT WITHHELD
3RD MONTH THIS QTR
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
WITHHELD
PERIOD
DUE ON
IDENTIFICATION NO.
7
AMOUNT
DUE
HAMTRAMCK INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF HAMTRAMCK
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
H941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE
1
AMOUNT WITHHELD
3401 EVALINE
4
HAMTRAMCK, MICHIGAN 48212
1ST MONTH THIS QTR
SIGNATURE
2
AMOUNT WITHHELD
VALIDATION AREA BELOW
2ND MONTH THIS QTR
3
TITLE
DATE
AMOUNT WITHHELD
3RD MONTH THIS QTR
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
WITHHELD
PERIOD
DUE ON
IDENTIFICATION NO.
7
AMOUNT
DUE
HW-3
CITY OF HAMTRAMCK–ANNUAL RECONCILIATION • INCOME TAX WITHHELD
RETURN WITH FORMS
DUE ON OR BEFORE
IDENTIFICATION NO.
TAX WITHHELD
W-2 TO
AS SHOWN ON
CITY OF HAMTRAMCK
ATTACHED W2’S
INCOME TAX
1
3401 EVALINE
TAX PAID
HAMTRAMCK, MICHIGAN 48212
TOTALS FROM
REVERSE SIDE
NUMBER OF
W-2’S SUBMITTED
2
BALANCE
DUE
PAY IN FULL
THIS RETURN
3
SIGNATURE
OVERPAYMENT
ATTACH
TITLE
DATE
EXPLANATION
4

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