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Michigan Department of Treasury - City Tax Administration 
5253 (Rev. 05-22) Page 1 of 2                                                                                 City Schedule W 
                                                                                                               Continuation 
City of Detroit Withholding Tax Continuation Schedule - 2022 
Issued under authority of Public Act 284 of 1964, as amended. 
Type or print in blue or black ink.  
INSTRUCTIONS: Complete this form if you have more than eight (8) withholding statements or more than three (3) partnerships to list. 
This is a continuation of the City of Detroit  Withholding Tax Schedule (Form 5121). 

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 (List all additional withholding). 
    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 

9.                                                                                                          00                    00 

10.                                                                                                         00                    00 

11.                                                                                                         00                    00 

12.                                                                                                         00                    00 

13.                                                                                                         00                    00 

14.                                                                                                         00                    00 

15.                                                                                                         00                    00 

16.                                                                                                         00                    00 

17.                                                                                                         00                    00 

18.                                                                                                         00                    00 

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

                                                                                                                                  00 

                                                                                                                                  00 

                                                                                                                                  00 

+ 0000 2022 111 01 27 6 

2022 Form 5253, Page 2 of 2 
City of Detroit Withholding Tax Continuation 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. 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 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 another 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. 

9.                                                                                                      %                    00                00 
                    If column B is not 260 days, enter explanation. 

10.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

11.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

12.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

13.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

14.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

15.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

16.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

17.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

18.                                                                                                     %                    00                00 
                    If column B is not 260 days, enter explanation. 

+ 0000 2022 111 02 27 5