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          SF-941 
                                                                Employer's Return of Income Tax Withheld 
Tax Period (Month/Quarter)       Due Date         FEIN          *Number of Residents                                *Number of Non-Residents 
1st Quarter 2020                 April 30, 2020                 withheld for                                        withheld for

                                                                *Amount                                             *Amount

                                                                Total

Signature                  Title Date             Phone Number       This allocation is necessary due to the State of 
                                                                                                                    Michigan reporting requirements 
                                      Return this voucher with check or money order payable to: City of Springfield 
                                 Mail to: Springfield Income Tax Department 601 Avenue A Springfield MI 49037-7774 

          SF-941 
                                                                Employer's Return of Income Tax Withheld  

Tax Period (Month/Quarter)       Due Date         FEIN          *Number of Residents                                *Number of Non-Residents 
2nd Quarter 2020                 July 31, 2020                  withheld for                                        withheld for

                                                                *Amount                                             *Amount

                                                                Total 

Signature                  Title Date             Phone Number       This allocation is necessary due to the State of 
                                                                                                                    Michigan reporting requirements 
                                      Return this voucher with check or money order payable to: City of Springfield 
                                 Mail to: Springfield Income Tax Department 601 Avenue A Springfield MI 49037-7774 

          SF-941                                                Employer's Return of Income Tax Withheld 
Tax Period (Month/Quarter)       Due Date         FEIN          *Number of Residents                                *Number of Non-Residents 
                                 October 31, 2020               withheld for                                        withheld for
3rd Quarter 2020

                                                                *Amount                                             *Amount

                                                                Total 

Signature                  Title Date             Phone Number       This allocation is necessary due to the State of 
                                                                                                                    Michigan reporting requirements 
                                      Return this voucher with check or money order payable to: City of Springfield 
                                 Mail to: Springfield Income Tax Department 601 Avenue A Springfield MI 49037-7774 

          SF-941 
                                                                Employer's Return of Income Tax Withheld 

Tax Period (Month/Quarter)       Due Date         FEIN          *Number of Residents                                *Number of Non-Residents 
4th Quarter 2020                 January 31, 2021               withheld for                                        withheld for

                                                                *Amount                                             *Amount

                                                                Total 
Signature                  Title Date             Phone Number        This allocation is necessary due to the State of 
                                                                                                                    Michigan reporting requirements 
                                 Return this voucher with check or money order payable to: City of Springfield 
                                 Mail to: Springfield Income Tax Department 601 Avenue A Springfield MI 49037-7774