2020  CF-W-3                             CITY OF Grand Rapids                                   CF-W-3  2020
     EMPLOYER'S ANNUAL RECONCILIATION OF INCOME TAX WITHHELD
 1. Employer's, IRC Sec. 3504 agent's or CPEO's name                         6. Federal employer identification number

 2. Address (number, street and room or suite number)                        7. Due on or before
                                                                             February 28, 2021
 3. City, state and zip code                           4. State  5. Zip code
                                                                                                Revised 10/15/2015

 8a. If line 1 is a Sec. 3504 agent or a CPEO, enter client employer's name  8b.FEIN of employer listed on line 8a

               SUMMARY OF TAX WITHHELD AND WITHHOLDING TAX PAID
              MONTH/QUARTER                            TAX WITHHELD                    WITHHOLDING TAX PAID
01M  January 
02M  February
01Q  March/First Quarter
     FIRST QUARTER TOTAL                               
04M  April
05M  May
02Q  June/Second Quarter
     SECOND QUARTER TOTAL                              
07M  July
08M  August
03Q  September/Third Quarter
     THIRD QUARTER TOTAL                               
10M  October
11M  November
04Q  December/Fourth Quarter
     FOURTH QUARTER TOTAL                              

  9. TOTAL WITHHOLDING TAX PAID (Sum of withholding tax       
X    payments reported in column above)                                              9.
10. NUMBER OF FORMS W-2 ATTACHED                                            10.
11. TOTAL TAX WITHHELD PER FORMS W-2                                        11.
12. BALANCE DUE (Line 9 less line 11)                                       12.
13. OVERPAYMENT (Line 11 less line 9)    *ATTACH EXPLANATION                13.

     * Submit a letter to request a refund. Include a detailed explanation on the                                       
     cause of the overpayment. Refunds will not be issued without an explanation.
Attach Forms W-2 (elctronic format or paper copy) and payment of any balance due (line 12.)

Under penalties of perjury, I declare that I have examined this return and accompanying 
documents and, to the best of my knowledge and belief, they are true, correct, and complete.
14. SIGNATURE                  15. NAME AND TITLE (PLEASE PRINT)            16. DATE            17. PHONE NUMBER

Enclose the required copies of Forms W-2 and, if necessary, payment of any balance due and/or 
Form CF-W-3S with Form CF-W-3

Mail to:Grand Rapids Income Tax Department
     Po Box 347
     Grand Rapids MI 49501-0347