Form J941-501 - Jackson Income Tax Withheld - 2013
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1
2JACKSON INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF JACKSON
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
J 941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE.
1
161 W. MICH. AVE.
AMOUNT WITHHELD
2013-1
PERIOD
DUE ON
IDENTIFICATION NO.
JACKSON, MICHIGAN
1ST MONTH: JAN.
1-1-13 to 3-31-13
4-30-13
2
AMOUNT WITHHELD
2ND MONTH: FEB.
3
AMOUNT WITHHELD
3RD MONTH: MARCH
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
SIGNATURE
WITHHELD
7
AMOUNT
DUE
TITLE
DATE
JACKSON INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF JACKSON
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
J 941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE.
1
161 W. MICH. AVE.
AMOUNT WITHHELD
2013-2
PERIOD
DUE ON
IDENTIFICATION NO.
JACKSON, MICHIGAN
1ST MONTH: APRIL
4-1-13 to 6-30-13
7-31-13
2
AMOUNT WITHHELD
2ND MONTH: MAY
3
AMOUNT WITHHELD
3RD MONTH: JUNE
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
SIGNATURE
WITHHELD
7
AMOUNT
DUE
TITLE
DATE
JACKSON INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF JACKSON
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
J 941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE.
1
161 W. MICH. AVE.
AMOUNT WITHHELD
2013-3
PERIOD
DUE ON
IDENTIFICATION NO.
JACKSON, MICHIGAN
1ST MONTH: JULY
7-31-13 to 9-30-13
10-31-13
2
AMOUNT WITHHELD
2ND MONTH: AUG.
3
AMOUNT WITHHELD
3RD MONTH: SEPT.
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
SIGNATURE
WITHHELD
7
AMOUNT
DUE
TITLE
DATE
JACKSON INCOME TAX WITHHELD
MAKE CHECK
TREASURER CITY OF JACKSON
IF FINAL RETURN, CHECK HERE AND COMPLETE
& MAIL TO
J 941-501
Income Tax
QUESTIONS ON THE REVERSE SIDE.
1
161 W. MICH. AVE.
AMOUNT WITHHELD
2013-4
PERIOD
DUE ON
IDENTIFICATION NO.
JACKSON, MICHIGAN
1ST MONTH: OCT.
10-1-13 to 12-31-13
1-31-14
2
AMOUNT WITHHELD
2ND MONTH: NOV.
3
AMOUNT WITHHELD
3RD MONTH: DEC.
4
TOTAL TAX WITHHELD
THIS QUARTER
5
ADJUSTMENT
6
ADJUSTED TAX
SIGNATURE
WITHHELD
7
AMOUNT
DUE
TITLE
DATE
JW-3 2013
CITY OF JACKSON — ANNUAL RECONCILIATION • INCOME TAX WITHHELD
Attach Copies of W-2’s
TAX WITHHELD
DUE ON OR BEFORE
IDENTIFICATION NO.
*Showing City Withholding
AS SHOWN ON
February 28, 2014
ATTACHED W2’S
CITY OF JACKSON
1
INCOME TAX
161 W. MICH. AVE.
TAX PAID
JACKSON, MICHIGAN 49201
TOTALS FROM
REVERSE SIDE
2
NUMBER OF
BALANCE DUE
W-2’S SUBMITTED
PAY IN FULL
THIS RETURN
TOTAL NUMBER
3
OF EMPLOYEES
SIGNATURE
OVERPAYMENT
ATTACH
EXPLANATION
TITLE
DATE
4
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