HP - 941 City of Highland Park- Income Tax Divison                                                                               1 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
                                                                                                          Interest due 
Signature _______________________________________________________  Date _________________                 (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  JANUARY 1M
                                                                                                            DUE DATE                     February 28, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              2 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  FEBRUARY 2M
                                                                                                            DUE DATE                     March 31, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              3 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  MARCH 3M
                                                                                                            DUE DATE                     April 30, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                             Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                              Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                                                                          Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamrtamck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

HP - 941 City of Highland Park - Income Tax Divison                                                                              4 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  APRIL 4M
                                                                                                            DUE DATE                     May 31, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              5 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  MAY 5M
                                                                                                            DUE DATE                     June 30, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              6 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  JUNE 6M
                                                                                                            DUE DATE                     July 31, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                             Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                              Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                                                                          Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamrtamck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

HP - 941 City of Highland Park - Income Tax Divison                                                                              7 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  JULY 7M
                                                                                                            DUE DATE                     August 31, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              8 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  AUGUST 8M
                                                                                                            DUE DATE                     September 30, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                              9 M            2021
            Employer’s Return of Income Tax Withheld                                                      Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park           Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                               Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                 Interest due 
                                                                                                          (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                          TOTAL DUE
                                                                                                          PAY THIS AMOUNT

                                                                                                          FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                            TAX YEAR                     2021
                                                                                                           PAYROLL PERIOD  SEPTEMBER 9M
                                                                                                            DUE DATE                     October 31, 2021
                                                                                                                                 
                                                                                                                               DO NOT WRITE BELOW THIS LINE

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                             Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                              Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamtramck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2.                                                                                                                                                                        1.
                                                              �                                                                                                                                  Your current address �                                                                                                                                                       �                                                                                                            �                                                                �                                                                                                   � applicable questions Check reason for “Final Return” and answer withheld ___________________________                                                                                                                                          Last pay period on which Hamtramck Taxes were
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Hamrtamck Zip Code               State                      City                       Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                              (Date) Operations will be resumed on Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                         ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                    __________________________                            _________________________ _________________________                  __________________________                                                                    __________________________
                                                                                        _______________________                                                                                                                              _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Ceased paying wages

HP - 941 City of Highland Park - Income Tax Divison                                                                                             10 M            2021
            Employer’s Return of Income Tax Withheld                                                                     Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park                          Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments                Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                                              Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                               per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                                Interest due 
                                                                                                                         (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                                         TOTAL DUE
                                                                                                                         PAY THIS AMOUNT

                                                                                                                         FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                                           TAX YEAR                     2021
                                                                                                                          PAYROLL PERIOD  OCTOBER 10M
                                                                                                                           DUE DATE                     November 30, 2021
                                                                                                                                                
                                                                                                                                              DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                                             11 M            2021
            Employer’s Return of Income Tax Withheld                                                                     Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park                          Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments                Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                                              Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                               per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                                Interest due 
                                                                                                                         (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                                         TOTAL DUE
                                                                                                                         PAY THIS AMOUNT

                                                                                                                         FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                                           TAX YEAR                     2021
                                                                                                                          PAYROLL PERIOD  NOVEMBER 11M
                                                                                                                           DUE DATE                     Decenber 31, 2021
                                                                                                                                                
                                                                                                                                              DO NOT WRITE BELOW THIS LINE

HP - 941 City of Highland Park - Income Tax Divison                                                                                             12 M            2021
            Employer’s Return of Income Tax Withheld                                                                     Tax withheld                   ____________________________________
                                                               Make remittance payable to:
If this is your first return, enter date this                  Treasurer, City of Highland Park                          Adjustments                    ____________________________________
business was started _______________________________           Mail to:
If this is final return, or employer status has changed,       City of Highland Park Withholding Payments                Net tax withheld               ____________________________________
see back of form for required information to be submitted.     P.O. Box 239                                              Late payment penalty - 1%
I certify the tax withheld as shown on this return is correct. Eaton Rapids, MI 48827-0530                               per month ($2.00 minimum)      ____________________________________
Signature _______________________________________________________  Date _________________                                Interest due 
                                                                                                                         (contact city for daily rates) ____________________________________
Phone # ____________________________________________
                                                                                                                         TOTAL DUE
                                                                                                                         PAY THIS AMOUNT

                                                                                                                         FEDERAL EMPLOYER ID #          ____________________________________
                                                                                                                           TAX YEAR                     2021
                                                                                                                          PAYROLL PERIOD  DECEMBER 12M
                                                                                                                           DUE DATE                     January 31, 2022
                                                                                                                                                
                                                                                                                                              DO NOT WRITE BELOW THIS LINE

                                              CITY OF HIGHLAND PARK-INCOME TAX DIVISION
                                              RECONCILATION OF HIGHLAND PARK INCOME TAX WITHHELD                                                  Copies of HPW-2s must accompany this document.
2021                            1. TOTAL HIGHLAND PARK TAX WITHHELD DURING YEAR AS SHOWN ON FORMS HPW-2 OR W-2 ENCLOSED                         $                                                                                                                           2021
                                                                                                                                                            (A)
HPW-3                                                                                                                                                                                                                                                                       HPW-3
                                2. TOTAL NUMBER OF WITHHOLDING TAX STATEMENTS (FORMS HPW-2 OR W-2) TRANSMITTED HEREWITH
                                                                                                                          QUARTER ENDED
IMPORTANT                       3. TOTAL HIGHLAND PARK TAX WITHHELD AS SHOWN ON FORMS HP-941                              MARCH 31              $                                                                                                                           DUE ON
                                                                                                                          JUNE 30
INFORMATION                                 (use otherside if forms HP-941 were filed monthly)                            QUARTER ENDED                                                                                                                                     OR 
                               THE NAME ADDRESS AND INDENTIFICATION NUMBER ON THIS FORM MUST BE THE SAME AS USED ON       QUARTER ENDED                                                                                                                                     BEFORE
GROSS PAYROLL                                            FORMS HP-941 AND HPW-2 OR W-2.  IF NOT CORRECT , PLEASE CORRECT  SEPETMBER 30                                                                                                                                      2/28/2022
USED TO CALCULATE                                                                       NAME AND ADDRESS                  QUARTER ENDED
                                                                                                                          DECEMBER 31
PAYROLL TAX                                                                                                               TOTAL PAYMENT         $           (B)
                                                                                                                          TO HIGHLAND PARK
                                                                                                                          DIFFERENCE            $           (A-B)
$ ____________________________                                                                                            EMPLOYER IDENTIFICATION NO.

                                                                  SIGNATURE                                                      TITLE                                                                             DATE                                              PHONE #

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   2.                                                                                                                                                              1. 
                                                              �                                                                                                                                  Your current address �                                                                                                                                                                                      �                                                                                                            �                                                                                                   �                                                                                                   � applicable questions                              Check reason for “Final Return” and answer taxes were withheld_____________________                                                                             Last pay period on which Highland Park
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Highland Park Zip Code                                   State                      City                              Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                                                  (Date)       Operations will be resumed on          Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                                                 ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                                            __________________________                                   _________________________ _________________________                  __________________________                                                                                        __________________________
                                                                                        _______________________                                                                                                                                  _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Ceased paying wages

                                                              4.                                                                                                                                 3.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   2.                                                                                                                                                                                                    1. 
                                                              �                                                                                                                                  Your current address �                                                                                                                                                                                      �                                                                                                            �                                                                                                   �                                                                                                   � applicable questions                              Check reason for “Final Return” and answer taxes were withheld_____________________                                                                                                                   Last pay period on which Highland Park
______________________________ ______________________________ Other:                    Zip Code                State                      City                        Street                                         Moved out of Highland Park Zip Code                                   State                      City                              Street                    Name                      Business sold to (Date)                     Wages will be paid starting                   Still operating –                                                  (Date)       Operations will be resumed on          Business temporarily discontinued                                  Business permanently discontinued
                                                                                                                                           ___________________________                                                                                                                                                 ___________________________
                                                              _________________________                         __________________________                             _________________________                                                                                            __________________________                                   _________________________ _________________________                  __________________________                                                                                        __________________________
                                                                                        _______________________                                                                                                                                  _______________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Ceased paying wages

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

                                                                                                                YEARLY TOTAL $             4TH QUARTER TOTAL $         DECEMBER                  NOVEMBER             OCTOBER                                           3RD QUARTER TOTAL $ SEPTEMBER                                             AUGUST JULY                      2ND QUARTER TOTAL $       JUNE             MAY                        APRIL                                                              1ST QUARTER TOTAL $                                  MARCH                               FEBRUARY                                   JANUARY                                                                                  LIST PAYMENTS MADE WITH HP941
                                                                                                                                                                                                                                                                                                                                                                                                              
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Eaton Rapids, MI 48827-0530
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    EMPLOYER’S RETURNS
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Income Tax Division                      City of Highland Park
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 SUMMARY                                                                                                                                                                                                                     P.O. Box 239