MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       1 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
1-2023 M       2-28-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       2 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
2-2023 M       3-31-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       3 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
3-2023 M       4-30-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       4 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
4-2023 M       5-31-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       5 M         2023              & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
5-2023 M       6-30-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       6 M         2023              & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
6-2023 M       7-31-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       7 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
7-2023 M       8-31-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       8 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
8-2023 M       9-30-23                                                                                                     Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       9 M          2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
9-2023 M       10-31-23                                                                                                    Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                                 MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD       10 M         2023             & MAIL TO TREASURER CITY OF PONTIAC
QUESTIONS ON THE REVERSE SIDE.                                               P 941                                         Mail to:
                                                                                                                           City of Pontiac 
PERIOD         DUE ON                   IDENTIFICATION NO.                         TAX WITHHELD
10-2023 M      11-30-23                                                                                                    Withholding Payments
                                                                                                                           P.O. Box 530
                                                                                   ADJUSTMENTS                             Eaton Rapids, MI 48827-0530

                                                                                   NET TAX WITHHELD
                                                                                   LATE PAYMENT PENALTY - 1%
                                                                                   PER MONTH ($2.00 MINIMUM) 
                                                                                   INTEREST DUE 
                                                                                   (CONTACT CITY FOR DAILY RATES)
               SIGNATURE                                                           TOTAL DUE
                                                                                   PAY THIS AMOUNT
         TITLE                          DATE

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________

                                                                                                 4.                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2.                                                                                                                     1. 
                                                                                                    ■                                                                               Your current address:                      ■                                                                                                                              ■                                                                                                                                             ■                                                                                                                                     ■                                                                   ■ applicable questions: Check reason for “Final Return” and answer were withheld _______________________                                       Last pay period on which Pontiac Taxes
                                                                                                  Other:                    City                         Street                                           Moved out of Pontiac   City                        Street                                               Name                      Business sold to:   (Date)___________________________ Wages will be paid starting                                        Still operating - Ceased paying wages.   (Date)___________________________ Operations will be resumed on                                   Business temporarily discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                            ____________________________                                                                         ____________________________
                                                                                                 __________________________                              __________________________                                                                          __________________________                           __________________________