Form                                               City of Port Huron Income Tax 
                                                                                                                                     202  
PH-W3                                  Reconciliation of Port Huron Income Tax Withheld                                                   2
Instructions are on the reverse side                                                                           DUE FEBRUARY 28, 202 3

Total Port Huron tax withheld during the year, as shown on the enclosed withholding statements (W-2's) 
Total number of withholding statements (W-2's) sent with this reconciliation 
Total Port Huron tax withheld, as paid with Forms PH-941 (detail below if PH-941's 3a. Quarter ended Mar 31 
                                                         were filed monthly) 
Federal Employer Identification Number 
                                                                                   3b. Quarter ended Jun 30 
Employer name and address                                                          3c. Quarter ended Sep 30 
                                                                                   3d. Quarter ended Dec 31 
                                                                                   Total withholding remitted 
                                                                                   DIFFERENCE see instructions 
Signature                                          Title                                  Date                        for city use 
                                                                                                               W-2's 
                                                                                                               PH-941 

INSTRUCTIONS FOR FORM PH-W3 
1. By the last day of February following each calendar year, you must furnish to the city the following:
   a)        A completed copy of this form (PH-W3).
   b)        An information return for each person who had income subject to city tax. The form must state the employee's name, social
             security number, address, compensation received and city tax withheld. The return must be a copy of the federal W-2 or a form
             furnished or approved by the city. Employers wishing to file W-2 information via magnetic media are encouraged to do so.
             Specifications are available from the city on request.

2. Show the total Port Huron tax withheld (as reported on the enclosed forms W-2) on line 1. Show the total tax withheld that you paid to the
city on line 4. Detail payments made in the appropriate area of the form. If a difference exists between the tax withheld reported on the W-2's
and the total paid to the city, show the difference on line 5. Any underpayment over $1.00 must be paid with this form. Attach a brief statement
explaining any overpayment. The city will verify and refund overpayments reported on form PH-W3 .
3. Mail this form, along with Forms W-2 and any payment to:        Income Tax Division  
                                                                   100 McMorran Boulevard 
                                                                   Port Huron, MI 48060 

Make checks payable to: City of Port Huron. Questions? Please call (810) 984-9741 or email incometax@porthuron.org. 

If you remitted the payments monthly, please list the amounts: 

     JAN                                    MAY                                         SEP 
     FEB                                    JUN                                         OCT 
     MAR                                    JUL                                         NOV 
     APR                                    AUG                                         DEC