Form 3121 - Authorized Eft Signature Page For City Of Albion Taxes

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Michigan Department of Treasury, CTU
3121 (Rev. 9-97)
AUTHORIZED EFT SIGNATURE PAGE FOR CITY OF ALBION TAXES
Issued under P.A. 284 of 1964, as amended.
Filing is mandatory.
This signature page must be submitted when a taxpayer is paying City of Albion taxes by
electronic funds transfer (EFT). Because no tax return is filed when paying by EFT, the signature
on this form is considered as if it actually appears on the electronically filed payment. This
signature page must be resubmitted when there is a change in the officer responsible for filing
and paying City of Albion withholding and corporate or partnership estimated payments of city
income taxes.
Company Name
Federal Identification Number
Address (No. and Street or RR#)
City, State, ZIP
Signature of officer responsible for reporting City of Albion withholding tax
Date
Type or Print Name
Title
Signature of officer responsible for paying City of Albion withholding tax (if different from above)
Date
Type or Print Name
Title
Signature of officer responsible for reporting City of Albion estimated income tax
Date
Type or Print Name
Title
Signature of officer responsible for paying City of Albion estimated income tax (if different from above)
Date
Type or Print Name
Title
If you have questions, please call:
Mail to: City Tax Unit
(517) 241-1882.
Michigan Department of Treasury
P.O. Box 30665
Lansing, Michigan 48909-8165

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