Mail W-2's and        CITY OF LAPEER
2019 LW-3 - LAPEER INCOME TAX ANNUAL RECONCILIATION                       balance due           INCOME TAX DEPT
                                                                          with this form to:    576 LIBERTY PARK
                                                                                                LAPEER MI  48446
DUE ON OR BEFORE         FEDERAL EMPLOYER ID #                                   Tax Withheld -Total of 
2/28/2020                                            # of W-2's Submitted        attached W-2's            $
Business Name & Address:                             # of Lapeer City            Tax Paid - Total from 
                                                     Employees                   Reverse Side              $
                                                         Gross Wages (W-2 Box 1) Balance Due - Tax W/H 
                                                                                 greater than Tax Paid     $
                                                       $                         Overpaid-Tax Paid greater 
                                                                                 than Tax W/H - Attach 
                                                                                 explanation               $

Signature                                      Title                      Date                  Phone Number

          L941 PAYMENT SUMMARY

          January        $

          February       $

          March          $

          1st qtr Total  $

          April          $

          May            $

          June           $

          2nd qtr Total  $

          July           $

          August         $

          September      $

          3rd qtr Total  $

          October        $

          November       $

          December       $

          4th qtr Total  $

          TOTAL PAID     $