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Michigan Department of Treasury - City Tax Administration
5121 (Rev. 05-22) Page 1 of 2 City Schedule W

City of Detroit Withholding Tax Schedule - 2022
Issued under authority of Public Act 284 of 1964, as amended.
Type or print in blue or black ink.
INSTRUCTIONS: If you had city income tax withheld in 2022, youmust complete a Withholding Tax Schedule (City Schedule W) to claim the
withholding on your City Income Tax Return. Do not attach your W-2s. Include your completed City Schedule W with Form 5118, Form 5119, or
Form 5120. If you need additional space, complete the City of Detroit Withholding Tax Continuation Schedule (Form 5253).
1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789)

If a Joint Return, Spouse’s First Name M.I. Last Name
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
4. Return for the city of: City Code
DETROIT 170

PART 1: CITY TAX WITHHELD.
A B — Employer’s federal C D — Wages, tips and other E
Enter “X” for: identification number compensation from City income tax withheld
Filer orSpouse (Example: 38-1234567) Employer’s name Box 1 of W-2 (see instructions) from Box 19 of W-2

1. 00 00

2. 00 00

3. 00 00

4. 00 00

5. 00 00

6. 00 00

7. 00 00

8. 00 00

5.Total City Tax Withheld.Enter here and carry to Form 5118, line 17, Form 5119, lineor20 Form 5120, line 36. 00

PART 2: CITY TAX PAID FOR YOU BY A PARTNERSHIP
A B C
Name of Partnership Federal Identification Number Tax Paid

6. Total.Enter here and carry to Form 5118, line 19, Form 5119, line 22 orForm 5120, line 38. ................ 00

Check this box and complete the City of Detroit Withholding Tax Continuation Schedule (Form 5253) if you
have more than eight W-2s to report or had tax paid on your behalf by more than three partnerships.
NOTE:
• All wage income earned by residents is subject to tax. Residents should not complete Part 3 on page 2.
• Nonresidents and part-year residents who performed work both within and outside the city should complete Part 3 on page 2.

+ 0000 2022 104 01 27 5 Continue on page 2.

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2022 Form 5121, Page 2 of 2 
City of Detroit Withholding Tax Schedule                           Filer’s Full Social Security Number 

                                 NONRESIDENTS AND PART-YEAR RESIDENTS ONLY 
PART 3: WAGE ALLOCATION FOR NONRESIDENTS AND PART-YEAR RESIDENTS 
Part 3 applies only to nonresidents and part-year residents computing wages earned in Detroit. Do not complete Part 3 if all of your work 
is performed in Detroit because all wages are subject to tax. See instructions for additional information and definition of “days worked”. 
Residents do not complete Part 3 because all wages are subject to tax. All wages reported on Part 1 of this form will be allocated 100% 
to the City of Detroit if Part 3 is not completed. 
  A separate computation must be made for each W-2. If any column’s computation equals zero, enter “0”, do not leave blank. If both 
filer and spouse have income subject to allocation, figure them separately. The sum of wages earned in Detroit in column H should be 
reported on form 5119, line 9 or Form 5120, line 10, column B. If you need additional space, include a                      City of Detroit Withholding Tax 
Continuation Schedule (Form 5253). 

    A                B                   C        D                E              F                           G                   H 
                   Number of     Number of      Actual number 
                   days paid     vacation days,  of days worked    Actual         Percentage of 
                   (5 day week x holidays, and  everywhere.        number of      days worked in         Total wages shown on W-2 Wages earned in Detroit. 
   Enter “X” for:  52 weeks      other days not Subtract           days worked in Detroit.               (City Schedule W)        Multiply G by percentage 
   Filer orSpouse  = 260 days)   worked.        C from B.          Detroit        Divide E by D.         (see instructions)       in F. 

1.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

2.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

3.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

4.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

5.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

6.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

7.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

8.                                                                                                     %                    00          00 
                   If column B is not 260 days, enter explanation. 

NOTE: If your City of Detroit allocation is less than 100 percent, please obtain a letter from your employer to verify columns B through E 
of Form 5121 and retain your work log. Treasury may request a copy of your work log and employer letter. 

+ 0000 2022 104 02 27 4

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