MAKE CHECK
IF FINAL RETURN, CHECK HERE AND COMPLETECITY OF PONTIAC - INCOME TAX WITHELD                                           11 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
11-2023 M                      12-31-23                                                                                                                  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                                           12 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
12-2023 M                      1-31-24                                                                                                                   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

                                        CITY OF PONTIAC-INCOME TAX DIVISION
                                        RECONCILIATION OF PONTIAC INCOME TAX WITHHELD                                                     Copies of PW-2s must accompany this document.
2023                            1. TOTAL PONTIAC TAX WITHHELD DURING YEAR AS SHOWN ON FORMS PW-2 OR W-2 ENCLOSED                                                                                                                                                              2023
PW-3                                                                                                                                   $            (A)                                                                                                                       PW-3
                                2. TOTAL NUMBER OF WITHHOLDING TAX STATEMENTS (FORMS PW-2 OR W-2) TRANSMITTED HEREWITH
                                                                                                                       QUARTER ENDED
IMPORTANT                       3. TOTAL PONTIAC TAX WITHHELD AS SHOWN ON FORMS P-941                                  MARCH 31        $                                                                                                                                      DUE ON
                                            (use other side if forms P-941 were filed monthly)                         QUARTER ENDED
INFORMATION                                                                                                            JUNE 30         $                                                                                                                                      OR 
                               THE NAME ADDRESS AND IDENTIFICATION NUMBER ON THIS FORM MUST BE THE SAME AS USED ON
                                                         FORMS P-941 AND PW-2 OR W-2.  IF NOT CORRECT , PLEASE CORRECT QUARTER ENDED   $                                                                                                                                      BEFORE
                                                                                                                       SEPTEMBER 30
GROSS PAYROLL                                                                           NAME AND ADDRESS               QUARTER ENDED   $
USED TO CALCULATE                                                                                                      DECEMBER 31                                                                                                                                            2/28/2024
PAYROLL TAX                                                                                                            TOTAL PAYMENTS
                                                                                                                       TO PONTIAC      $            (B)
                                                                                                                       DIFFERENCE      $            (A-B)
$ ____________________________                                                                                         EMPLOYER IDENTIFICATION NO.

                               SIGNATURE                                                                                           TITLE                                                                             DATE                                              PHONE #

                                                                                                                                    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 
________________________________                                 ________________________________
                                                                                                                                                                 ____________________________                                                                                                                                                          ____________________________
                                                                                                                                    __________________________                                         __________________________                                                                                                                                                            __________________________                           __________________________

                                                                                                                                                                                                                                                                          ____________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
                                                                                                  ____________________ QUARTER ENDED DEC. 31                     ____________________         DECEMBER ____________________       NOVEMBER ____________________  OCTOBER                                                        QUARTER ENDED SEPT. 30 ____________________        SEPTEMBER ____________________ AUGUST ____________________                               JULY ____________________ QUARTER ENDED JUNE 30            ____________________              JUNE ____________________        MAY ____________________                                                        APRIL ____________________ QUARTER ENDED MARCH 31  ____________________          MARCH ____________________ FEBRUARY                                    ____________________                                               JANUARY                          _________________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                LIST PAYMENTS MADE WITH P941
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Eaton Rapids, MI 48827-0530
                                 TOTAL PAID $                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        EMPLOYERS RETURNS.                                                                                                                                                                                                               Income Tax Division
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  SUMMARY                                                                                                P.O. Box 530                    City of Pontiac

                                 ___________

                                                                                                  . . . . . . . . . . . . . . . . .                            $                                                                                                         . . . . . . . . . . . . . . . . .                      $                                                                                                                                                . . . . . . . . . . . . . . . . .                   $                                                                                                                                                          . . . . . . . . . . . . . . . . .           $