HAMTRAMCK INCOME TAX WITHHELD                                                      MAKE CHECK
                            IF FINAL RETURN, CHECK HERE AND COMPLETE                                           & MAIL TO        CITY OF HAMTRAMCK
                            QUESTIONS ON THE REVERSE SIDE                         H941-501                                        Withholding Payment
                                                                                           AMOUNT WITHHELD 1                          P.O. BOX 209
                                                                                           1ST MONTH THIS QTR             EATON RAPIDS, MI 48827-0209
                          1                SIGNATURE                         PHONE #
                                                                                           AMOUNT WITHHELD 2              VALIDATION AREA BELOW
                                                                                           2ND MONTH THIS QTR
                                   TITLE                                     DATE          AMOUNT WITHHELD 3
                                                                                           3RD MONTH THIS QTR
                                                                                           TOTAL TAX WITHHELD 4
                                                                                           THIS QUARTER
                                                                                                              5
                                                                                           ADJUSTMENT
                                                                                           ADJUSTED TAX       6
                                                                                           WITHHELD
MAIL IN SUPPLIED ENVELOPE   PERIOD            DUE ON                 IDENTIFICATION NO.    AMOUNT             7
                            1-1-18 to 3-31-18 4-30-18                                      DUE

                            HAMTRAMCK INCOME TAX WITHHELD                                                      MAKE CHECK
                            IF FINAL RETURN, CHECK HERE AND COMPLETE                                           & MAIL TO        CITY OF HAMTRAMCK
                            QUESTIONS ON THE REVERSE SIDE                         H941-501                                        Withholding Payment
                                                                                           AMOUNT WITHHELD 1                          P.O. BOX 209
                                                                                           1ST MONTH THIS QTR             EATON RAPIDS, MI 48827-0209
                          2                SIGNATURE                         PHONE #
                                                                                           AMOUNT WITHHELD 2              VALIDATION AREA BELOW
                                                                                           2ND MONTH THIS QTR
                                   TITLE                                     DATE          AMOUNT WITHHELD 3
                                                                                           3RD MONTH THIS QTR
                                                                                           TOTAL TAX WITHHELD 4
                                                                                           THIS QUARTER
                                                                                                              5
                                                                                           ADJUSTMENT
                                                                                           ADJUSTED TAX       6
                                                                                           WITHHELD
MAIL IN SUPPLIED ENVELOPE   PERIOD            DUE ON                 IDENTIFICATION NO.    AMOUNT             7
                          4-1-18 to 6-30-18   7-31-18                                      DUE

                            HAMTRAMCK INCOME TAX WITHHELD                                                      MAKE CHECK
                            IF FINAL RETURN, CHECK HERE AND COMPLETE                                           & MAIL TO        CITY OF HAMTRAMCK
                            QUESTIONS ON THE REVERSE SIDE                         H941-501                                        Withholding Payment
                                                                                           AMOUNT WITHHELD 1                          P.O. BOX 209
                                                                                           1ST MONTH THIS QTR             EATON RAPIDS, MI 48827-0209
                          3                SIGNATURE                         PHONE #
                                                                                           AMOUNT WITHHELD 2              VALIDATION AREA BELOW
                                                                                           2ND MONTH THIS QTR
                                   TITLE                                     DATE          AMOUNT WITHHELD 3
                                                                                           3RD MONTH THIS QTR
                                                                                           TOTAL TAX WITHHELD 4
                                                                                           THIS QUARTER
                                                                                                              5
                                                                                           ADJUSTMENT
                                                                                           ADJUSTED TAX       6
                                                                                           WITHHELD
MAIL IN SUPPLIED ENVELOPE   PERIOD            DUE ON                 IDENTIFICATION NO.    AMOUNT             7
                          7-1-18 to 9-30-18   10-31-18                                     DUE

                            HAMTRAMCK INCOME TAX WITHHELD                                                      MAKE CHECK
                            IF FINAL RETURN, CHECK HERE AND COMPLETE                                           & MAIL TO        CITY OF HAMTRAMCK
                            QUESTIONS ON THE REVERSE SIDE                         H941-501                                        Withholding Payment
                                                                                           AMOUNT WITHHELD 1                          P.O. BOX 209
                                                                                           1ST MONTH THIS QTR             EATON RAPIDS, MI 48827-0209
                          4                SIGNATURE                         PHONE #
                                                                                           AMOUNT WITHHELD 2              VALIDATION AREA BELOW
                                                                                           2ND MONTH THIS QTR
                                   TITLE                                     DATE          AMOUNT WITHHELD 3
                                                                                           3RD MONTH THIS QTR
                                                                                           TOTAL TAX WITHHELD 4
                                                                                           THIS QUARTER
                                                                                                              5
                                                                                           ADJUSTMENT
                                                                                           ADJUSTED TAX       6
                                                                                           WITHHELD
MAIL IN SUPPLIED ENVELOPE   PERIOD            DUE ON                 IDENTIFICATION NO.    AMOUNT             7
                          10-1-18 to 12-31-18 1-31-19                                      DUE

                            CITY OF HAMTRAMCK–ANNUAL RECONCILIATION • INCOME TAX WITHHELD                                            HW-3
                          DUE ON OR BEFORE                IDENTIFICATION NO.               RETURN WITH FORMS             TAX WITHHELD
                                                                                           W-2 TO                        AS SHOWN ON
                                                                                           CITY OF HAMTRAMCK             ATTACHED W2’S
                                                                                           WITHHOLDING PAYMENT           1
                                                                                           P.O BOX 209                    TAX PAID
                                                                                           EATON RAPIDS, MI 48827-0209   TOTALS FROM
                                                                                           NUMBER OF                     REVERSE SIDE
                                                                                           W-2’S SUBMITTED               2
                                                                                                                          BALANCE
                                                                                                                          DUE
                                                                                                                          PAY IN FULL
                                                                                                                         THIS RETURN
                                           SIGNATURE                         PHONE #                                     3
                                                                                                                         OVERPAYMENT
                            TITLE                                            DATE                                         ATTACH
MAIL IN SUPPLIED ENVELOPE                                                                                                EXPLANATION
                                                                                                                         4

                                                                                                                                                                                                                                                                                                                                                                                                                       $                                                                                                                                                                                                                                          $                                                                                                                                                                                                                                          $                                                                                                                                                                                                                                                 $

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               __________

                                            SUMMARY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            TOTAL PAID $
                                                                                                                                                             EMPLOYERS RETURNS.

                                                                                 LIST PAYMENTS MADE WITH H941/501                                                                                    _______________________                                    ____________________                                    ____________________                               ____________________                        QUARTER ENDED MARCH 31 _______________________                                         ____________________                             ____________________                                    ____________________                       QUARTER ENDED JUNE 30 _______________________                            ____________________                                    ____________________                                         ____________________                         QUARTER ENDED SEPT. 30 _______________________                                ____________________                                      ____________________                                       ____________________                           QUARTER ENDED DEC. 31 _______________________                                    
                                                                                                                                                                                                                               JANUARY                                                 FEBRUARY                                                MARCH                                                                                                                    APRIL                                                        MAY                                             JUNE                                                                                                                        JULY                                                                       AUGUST                                                    SEPTEMBER                                                                                                                    OCTOBER                                                  NOVEMBER                                                   DECEMBER                                                                                                                                 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                __________________________                      __________________________                                                                                                                                                                                                                      __________________________                                                                                           __________________________
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ____________________________                                                                                                                                                                                                                      ____________________________

                                                                                                                                                                                                                              Business permanently discontinued                       Business temporarily discontinued                      Operations will be resumed on                                                                                             Still operating - Ceased paying wages.                      Wages will be paid starting                                                                               Business sold to:                                                                                                                                                                                                                        Moved out of Hamtramck                                                                                                                                                                                                                          Other:
   Last pay period on which Hamtramck taxes were withheld_______________________                                  Check reason for “Final Return” and answer                   applicable questions:                                                                                                                                                                                             (Date)___________________________                                                                                                                                                   (Date)___________________________                                                                                           Name                                            Street                                                  City                                                                                                                               Your current address:                                Street                                                    City                                                                                                                               ________________________________                                   ________________________________
   1.                                                                                                             2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        3.                                                                                                                                                                       4. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                __________________________                      __________________________                                                                                                                                                                                                                      __________________________                                                                                           __________________________
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ____________________________                                                                                                                                                                                                                      ____________________________

                                                                                                                                                                                                                              Business permanently discontinued                       Business temporarily discontinued                      Operations will be resumed on                                                                                             Still operating - Ceased paying wages.                      Wages will be paid starting                                                                               Business sold to:                                                                                                                                                                                                                        Moved out of Hamtramck                                                                                                                                                                                                                          Other:
   Last pay period on which Hamtramck taxes were withheld_______________________                                  Check reason for “Final Return” and answer                   applicable questions:                                                                                                                                                                                             (Date)___________________________                                                                                                                                                   (Date)___________________________                                                                                           Name                                            Street                                                  City                                                                                                                               Your current address:                                Street                                                    City                                                                                                                               ________________________________                                   ________________________________
   1.                                                                                                             2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        3.                                                                                                                                                                       4. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                __________________________                      __________________________                                                                                                                                                                                                                      __________________________                                                                                           __________________________
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ____________________________                                                                                                                                                                                                                      ____________________________

                                                                                                                                                                                                                              Business permanently discontinued                       Business temporarily discontinued                      Operations will be resumed on                                                                                             Still operating - Ceased paying wages.                      Wages will be paid starting                                                                               Business sold to:                                                                                                                                                                                                                        Moved out of Hamtramck                                                                                                                                                                                                                          Other:
   Last pay period on which Hamtramck taxes were withheld_______________________                                  Check reason for “Final Return” and answer                   applicable questions:                                                                                                                                                                                             (Date)___________________________                                                                                                                                                   (Date)___________________________                                                                                           Name                                            Street                                                  City                                                                                                                               Your current address:                                Street                                                    City                                                                                                                               ________________________________                                   ________________________________
   1.                                                                                                             2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        3.                                                                                                                                                                       4. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                __________________________                      __________________________                                                                                                                                                                                                                      __________________________                                                                                           __________________________
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ____________________________                                                                                                                                                                                                                      ____________________________

                                                                                                                                                                                                                              Business permanently discontinued                       Business temporarily discontinued                      Operations will be resumed on                                                                                             Still operating - Ceased paying wages.                      Wages will be paid starting                                                                               Business sold to:                                                                                                                                                                                                                        Moved out of Hamtramck                                                                                                                                                                                                                          Other:
   Last pay period on which Hamtramck taxes were withheld_______________________                                  Check reason for “Final Return” and answer                   applicable questions:                                                                                                                                                                                             (Date)___________________________                                                                                                                                                   (Date)___________________________                                                                                           Name                                            Street                                                  City                                                                                                                               Your current address:                                Street                                                    City                                                                                                                               ________________________________                                   ________________________________
   1.                                                                                                             2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        3.                                                                                                                                                                       4.