CITY OF GRAND RAPIDS
                                            INCOME TAX DEPARTMENT
                                 Who Must Make Estimated Tax Payments
      You must make estimated income tax payments for 2017 if you paid $101 or more with your 
      2016 Grand Rapids income tax return unless: 
                       1.  70 percent or more of your 2017 income tax is paid by tax withheld and/or tax credits.
                       2.  2017 tax withheld and/or tax credits are 70 percent or more of 2016 income tax. 

          Why You Received These Estimated Tax Payment Forms
      The estimated income tax forms enclosed with this notice have been mailed because you 
      made 2016 estimated payments or you paid over $100 of income tax with your 2015 Grand 
      Rapids income tax return. You need to review your 2016 return to see if you need to make 
      estimated income tax payments for 2017. See the enclosed instructions for direction.

Failure to make required estimated tax payments will result in assessment of interest and penalty.

                                            CITY OF GRAND RAPIDS
                                            INCOME TAX DEPARTMENT

FORM GR-1040ES-EFT               2017 ESTIMATED INCOME TAX PAYMENT FORM - DIRECT DEBIT PAYMENT

2017 estimated income tax payments may be made by an authorized direct debit withdrawal from your bank account. To pay your 
estimated income tax in this manner, use the form below or download Form GR-1040ES-EFT from the Grand Rapids website 
(www.grcity.us/income tax). Complete the form and mail it to the Income Tax Department, PO Box 347, Grand Rapids, MI 49501-
0347. 

To make an electronic direct debit payment, enter your social security number, name and address. Also enter your bank account 
information (a, b and c below), and the quarterly payment information for the quarter(s) to be paid. Complete the payment amount, 
the effective date for each payment and sign the form. You may provide information for payments to be withdrawn for one or more 
quarters. The payment date for each payment is the effective date entered. Generally, payments will be withdrawn within five 
business days of the effective date entered.     
                                                                                                                              Revised 05/16/2016
Social security number                                                Name

                                                                      Address
a.  Bank routing number:
                                                                      Address line 2
b.  Bank account number:
                                                                      City                                      State Zip code
c.  Bank account type:
 Checking                Savings                                      PAYMENT AMOUNT                   EFFECTIVE DATE FOR PAYMENT
d.  Quarterly estimated payments                                      (Round cents up to next dollar) (Payment date cannot be later than due date)
First quarter payment due May 2, 2017                                 ,             . 00              /         /

Second quarter payment due June 30, 2017                              ,             . 00              /         /

Third quarter payment due September 30, 2017                          ,             . 00              /         /

Fourth quarter payment due January 31, 2018                           ,             . 00              /         /
                                                                                                      Date format:  MM/DD/YYYY
Signature of taxpayer authorizing withdrawal from listed bank account   Mail to:  Grand Rapids Income Tax Department
                                                                                    PO Box 347
                                                                                    Grand Rapids, MI  49501-0347