Print Form
          BC-941                             City of Battle Creek 

                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents            *Number of Non-Residents
January                          February 28                                      withheld for                    withheld for 

                                                                                  *Amount                         *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                  Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: City of Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents            *Number of Non-Residents
                                                                                  withheld for                    withheld for 
February                         March 31

                                                                                  *Amount                         *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                  Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek   
                                 Mail to: City of Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents            *Number of Non-Residents
                                                                                  withheld for                    withheld for 
March                            April 30

                                                                                  *Amount                         *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                  Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: City of Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents            *Number of Non-Residents
                                                                                  withheld for                    withheld for 
April                            May 31

                                                                                  *Amount                         *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                  Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
May                              June 30

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek 
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents           *Number of Non-Residents
June                             July 31                                          withheld for                   withheld for 

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek 
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents           *Number of Non-Residents
July                             August 31                                        withheld for                   withheld for 

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek 
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                             City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date    FEIN                                 *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
August                           September 30

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date        Phone Number                                                This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                            City of Battle Creek 

                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date   FEIN                                  *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
September                        October 

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date       Phone Number                                                         This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                            City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date   FEIN                                  *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
October                          November 30

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date       Phone Number                                                         This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                            City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date   FEIN                                  *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
November                         December 31

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date       Phone Number                                                         This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657

          BC-941                            City of Battle Creek 
                                          Employer's Return of Income Tax Withheld
Tax Period (Month/Quarter)       Due Date   FEIN                                  *Number of Residents           *Number of Non-Residents
                                                                                  withheld for                   withheld for 
December                         January 31

                                                                                  *Amount                        *Amount 

                                                                                  Total 

Signature                  Title Date       Phone Number                                                         This allocation is necessary due to the State of 
                                                                                                                 Michigan reporting requirements
                                 Return this voucher with check or money order payable to: City of Battle Creek  
                                 Mail to: Battle Creek Income Tax P O Box 1657 Battle Creek MI 49016-1657