Form
                                                City of Port Huron Income Tax
PH-W3                                                                                                                      2019
                                      Reconciliation of Port Huron Income Tax Withheld
Instructions are on the reverse side                                                                                 DUE FEBRUARY 29, 2020

1.  Total Port Huron tax withheld during the year, as shown on the enclosed withholding statements (W-2's)
2.  Total number of withholding statements (W-2's) sent with this reconciliation
3.  Total Port Huron tax withheld, as paid with Forms PH-941 (detail below if PH-941's 3a. Quarter ended Mar 31
                                                               were filed monthly)
Federal Employer Identification Number
                                                                                       3b. Quarter ended Jun 30
Employer name and address                                                              3c. Quarter ended Sep 30
                                                                                       3d. Quarter ended Dec 31
                                                                                       4. Total withholding remitted
                                                                                       5. DIFFERENCE see instructions
Signature                                       Title                                  Date                                for city use
                                                                                                                     W-2's
                                                                                                                     PH-941

INSTRUCTIONS FOR FORM PH-W3

1.  By the last day of February following each calendar year, you must furnish to the city the following:
     a)   A completed copy of this form (PH-W3).
     b)   An information return for each person who had income subject to city tax.  The form must state the employee's name, social 
          security number, address, compensation received and city tax withheld.  The return must be a copy of the federal W-2 or a form
          furnished or approved by the city.  Employers wishing to file W-2 information via magnetic media are encouraged to do so.  
          Specifications are available from the city on request. 

2.  Show the total Port Huron tax withheld (as reported on the enclosed forms W-2) on line 1.  Show the total tax withheld that you paid to the
city on line 4.  Detail payments made in the appropriate area of the form.  If a difference exists between the tax withheld reported on the W-2's
and the total paid to the city, show the difference on line 5.  Any underpayment over $1.00 must be paid with this form.  Attach a brief statement
explaining any overpayment.  The city will verify and refund overpayments reported on form PH-W3 .
3.  Mail this form, along with Forms W-2 and any payment to:     Income Tax Division
                                                                 100 McMorran Boulevard
                                                                 Port Huron, MI   48060

Make checks payable to: City of Port Huron.     Questions? Please call (810) 984-9741 or email incometax@porthuron.org.

If you remitted the payments monthly, please list the amounts:

    JAN                               MAY                                              SEP
    FEB                               JUN                                              OCT
    MAR                               JUL                                              NOV
    APR                               AUG                                              DEC