CITY OF PORT HURON INCOME TAX                                                         Changes effective on (give date)
NOTICE OF CHANGE OR DISCONTINUANCE                                                    Federal Employer Identification Number (FEIN)
PH-5 (Revised 12/17)
Mailing address                                                                  CHANGE OUR MAILING ADDRESS TO:

Withholding address (if withholding forms are to be sent to a different address) CHANGE OUR WITHHOLDING ADDRESS TO:

1.    The Internal Revenue Service has assigned us a federal employer identification number
                                                                                                                             FEIN
2.    Our federal employer identification number as shown is wrong.  The correct number is:
                                                                                                                             FEIN
3.    We discontinued our business on                                            The address where we may be reached after the discontinuance of business:
                                                         Date

                    Number & Street                                              City                          State               ZIP code
4.    We are registered for withholding purposes only.  We are not doing business in the City of Port Huron and no longer wish to withhold the tax.

5.    We sold our business on:
                                                  SOLD
                    Date                          TO:
      If a partial sale, explain on the back                 Giver purchaser's name, street address, city, state and ZIP code

6.    Change in ownership (explain on the back of the form or in a attached statement).

7.    We have incorporated.  Our corporate name is:
                                                                                            Name
8.    We have added, eliminated, or changed the name of a business location in the City of Port Huron as follows:

                Business name in Port Huron (DBA)                                                                     Approximate number of employees
   DELETE
                Address in Port Huron (number and street)
   ADD
                Business name in Port Huron (DBA)                                                                     Approximate number of employees
   DELETE
                Address in Port Huron (number and street)
   ADD

9.    Other changes.  Explain on the back of this form or in an attached statement.

                                                             Name                               Telephone number & area code
If we have questions about this form who should we call?

Type or print the name of owner or officer responsible for filing tax returns          Title

Signature                                                                              Date

Return to: Income Tax Division, 100 McMorran Boulevard, Port Huron, MI   48060                  Questions? call (810) 984-9741