Income Tax Department                                                                CLEAR FORM
                                                           601 Avenue A, Springfield, MI 49037 
                                                           Phone: (269) 965-8324 
                                                           Fax: (269) 965-8211 
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                    Form SF W-3 Employer's Annual Reconciliation of SF-941 Payments 

      An employer is required to file with the City a reconciliation of SF-941 payments on or before the last day of February 
      following each calendar year in which the employer withheld Springfield City Income Tax from employee compensation. 
      If there is a balance due when the reconciliation is filed, this amount is payable at that time. If the employer made 
      SF-941 payments in excess of the amount withheld, the City upon verification will refund the overpayment. 

      In addition, all W-2's must be submitted with the annual reconciliation ( SF W-3 ). The W-2( s ) must show the following: 
            Employee's Name, Complete Address & Social Security Number 
            Total amount of compensation paid during the year ( box 1 ). 
            Locality name of city withholding ( box 20 ). 
            Total amount of compensation earned in Springfield ( box 18 ), whether or not you actually withheld the tax from this amount. 
            The amount of Springfield City Income Tax withheld ( box 19 ). 

      Any variation of the standard W-2 form must be pre-approved by the City. If an employer goes out of business or otherwise ceases to be 
      an employer, the reconciliation form ( SF W-3 ) and the information returns ( W-2's ) are to be filed with the City by the next SF-941 due 
      date. 
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SF W-3                                                                                                 FEIN:

Payment  Summary 
List payments made with form SF-941 Employer's Return                            Annual Reconciliation of Income Tax Withheld 

January             July                                                         1. Total Tax Withheld:

February            August                                                       2. Tax Paid (total from summary)

March               September                                                    3. Balance Due (line 1 less line ) pay in full with this Return

Quarter Ending 3/31 Quarter Ending 9/30                                          4. Over Payment if line 2 is greater than line 1explain below

April               October                                                      Over Payment Explanation 

May                 November 

June                December 
                                                                                    Employer's Name 
Quarter Ending 6/30 Quarter Ending 12/31 
                                                                                    Address 

Total Paid               Enter Total On Line 2 
                                                                                    City                         State          Zip Code 

                                                                                    Country 

Signature 

Print Name                                            Date                                             Return With W-2's to: 
                                                                                    City of Springfield Income Tax Department 
Title                      Phone Number                                                  This Report is Due on or before February 28th