Form H941-501 - Hamtramck Income Tax Withheld Page 2
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21. Last pay period on which Hamtramck taxes
1. Last pay period on which Hamtramck taxes
1. Last pay period on which Hamtramck taxes
1. Last pay period on which Hamtramck taxes
SUMMARY
were withheld _______________________
were withheld _______________________
were withheld _______________________
were withheld _______________________
LIST PAYMENTS MADE WITH H941/501
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
EMPLOYERS RETURNS.
applicable questions:
applicable questions:
applicable questions:
applicable questions:
_______________________
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
JANUARY
____________________
Business temporarily discontinued
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
Operations will be resumed on
MARCH
____________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
_______________________
QUARTER ENDED MARCH 31 $
Still operating - Ceased paying wages.
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
Wages will be paid starting
MAY
____________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
JUNE
____________________
Business sold to:
Business sold to:
Business sold to:
Business sold to:
_______________________
QUARTER ENDED JUNE 30
$
Name __________________________
Name __________________________
Name __________________________
Name __________________________
JULY
____________________
Street __________________________
Street __________________________
Street __________________________
Street __________________________
AUGUST
____________________
City ____________________________
City ____________________________
City ____________________________
City ____________________________
SEPTEMBER
____________________
Moved out of Hamtramck
Moved out of Hamtramck
Moved out of Hamtramck
Moved out of Hamtramck
_______________________
QUARTER ENDED SEPT. 30
$
3. Your current address:
3. Your current address:
3. Your current address:
3. Your current address:
OCTOBER
____________________
Street __________________________
Street __________________________
Street __________________________
Street __________________________
____________________
NOVEMBER
City ____________________________
City ____________________________
City ____________________________
City ____________________________
DECEMBER
____________________
4.
Other: __________________________
4.
Other: __________________________
4.
Other: __________________________
4.
Other: __________________________
_______________________
QUARTER ENDED DEC. 31
$
________________________________
________________________________
________________________________
________________________________
TOTAL PAID $ __________
________________________________
________________________________
________________________________
________________________________
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