HIGHLAND PARK INCOME TAX WITHHELD                                                                                                          MAKE CHECK
         IF FINAL RETURN, CHECK HERE AND COMPLETE                                                                                                    & MAIL TO    CITY OF HIGHLAND PARK
         QUESTIONS ON THE REVERSE SIDE                                                                                 HP941-501                                        Withholding Payment
                                                                                                                                 AMOUNT WITHHELD 1                          P.O BOX 239
                                                                                                                                 1ST MONTH THIS QTR               EATON RAPIDS, MI 48827-0239
1                                                        SIGNATURE                                                     PHONE #   AMOUNT WITHHELD 2
                                                                                                                                                                  VALIDATION AREA BELOW
                                                                                                                                 2ND MONTH THIS QTR
                        TITLE                                                                                          DATE      AMOUNT WITHHELD 3
                                                                                                                                 3RD MONTH THIS QTR
    2023                                                                                                                         TOTAL TAX WITHHELD 4
                                                                                                                                 THIS QUARTER
                                                                                                                                                    5
                                                                                                                                 ADJUSTMENT
                                                                                                                                 ADJUSTED TAX       6
                                                                                                                                 WITHHELD
         PERIOD                                                        DUE ON                             IDENTIFICATION NO.     AMOUNT             7
         1-1-23 to 3-31-231-1-071-1-12toto3-31-073-31-12               4-30-234-30-074-30-124-30-                                DUE

         HIGHLAND PARK INCOME TAX WITHHELD                                                                                                          MAKE CHECK
         IF FINAL RETURN, CHECK HERE AND COMPLETE                                                                                                    & MAIL TO    CITY OF HIGHLAND PARK
         QUESTIONS ON THE REVERSE SIDE                                                                                 HP941-501                                        Withholding Payment
                                                                                                                                 AMOUNT WITHHELD 1                          P.O BOX 239
                                                                                                                                 1ST MONTH THIS QTR               EATON RAPIDS, MI 48827-0239
2                                                                      SIGNATURE                                       PHONE #   AMOUNT WITHHELD 2
                                                                                                                                                                  VALIDATION AREA BELOW
                                                                                                                                 2ND MONTH THIS QTR
                        TITLE                                                                                          DATE      AMOUNT WITHHELD 3
                                                                                                                                 3RD MONTH THIS QTR
    2023                                                                                                                         TOTAL TAX WITHHELD 4
                                                                                                                                 THIS QUARTER
                                                                                                                                                    5
                                                                                                                                 ADJUSTMENT
                                                                                                                                 ADJUSTED TAX       6
                                                                                                                                 WITHHELD
         PERIOD                                                        DUE ON                             IDENTIFICATION NO.     AMOUNT             7
         4-1-23 to 6-30-234-1-074-1-124-1-12tototo6-30-126-30-126-30-077-32-237-31-127-31-197-31-07                              DUE

         HIGHLAND PARK INCOME TAX WITHHELD                                                                                                          MAKE CHECK
         IF FINAL RETURN, CHECK HERE AND COMPLETE                                                                                                    & MAIL TO       CITY OF HIGHLAND PARK
         QUESTIONS ON THE REVERSE SIDE                                                                                 HP941-501                                        Withholding Payment
                                                                                                                                 AMOUNT WITHHELD 1                          P.O BOX 239
                                                                                                                                 1ST MONTH THIS QTR               EATON RAPIDS, MI 48827-0239
3                                                                      SIGNATURE                                       PHONE #   AMOUNT WITHHELD 2
                                                                                                                                                                  VALIDATION AREA BELOW
                                                                                                                                 2ND MONTH THIS QTR
                        TITLE                                                                                          DATE      AMOUNT WITHHELD 3
                                                                                                                                 3RD MONTH THIS QTR
    2023                                                                                                                         TOTAL TAX WITHHELD 4
                                                                                                                                 THIS QUARTER
                                                                                                                                                    5
                                                                                                                                 ADJUSTMENT
                                                                                                                                 ADJUSTED TAX       6
                                                                                                                                 WITHHELD
         PERIOD                                                        DUE ON                             IDENTIFICATION NO.     AMOUNT             7
         7-1-23 to 9-30-237-1-077-1-12toto9-30-079-30-12               10-31-2310-31-0710-31-1210-31-1333                        DUE

         HIGHLAND PARK INCOME TAX WITHHELD                                                                                                          MAKE CHECK
         IF FINAL RETURN, CHECK HERE AND COMPLETE                                                                                                    & MAIL TO    CITY OF HIGHLAND PARK
         QUESTIONS ON THE REVERSE SIDE                                                                                 HP941-501                                        Withholding Payment
                                                                                                                                 AMOUNT WITHHELD 1                          P.O BOX 239
                                                                                                                                 1ST MONTH THIS QTR               EATON RAPIDS, MI 48827-0239
4                                                                      SIGNATURE                                       PHONE #   AMOUNT WITHHELD 2
                                                                                                                                                                  VALIDATION AREA BELOW
                                                                                                                                 2ND MONTH THIS QTR
                        TITLE                                                                                          DATE      AMOUNT WITHHELD 3
                                                                                                                                 3RD MONTH THIS QTR
    2023
                                                                                                                                 TOTAL TAX WITHHELD 4
                                                                                                                                 THIS QUARTER
                                                                                                                                                    5
                                                                                                                                 ADJUSTMENT
                                                                                                                                 ADJUSTED TAX       6
                                                                                                                                 WITHHELD
         PERIOD                                                        DUE ON                             IDENTIFICATION NO.     AMOUNT             7
         10-1-23 to 12-31-2310-1-12 to 12-31-12                        1-31-241-31-081-31-13                                     DUE

         CITY OF HIGHLAND PARK–ANNUAL RECONCILIATION• INCOME TAX WITHHELD                                                                                                  HPW-3
DUE ON OR BEFORE                                                                                    IDENTIFICATION NO.           RETURN WITH FORMS             TAX WITHHELD
         FebruaryFebruary2-28-2024 28,28,20082013                                                                                W-2 TO                        AS SHOWN ON
                                                                                                                                 CITY OF HIGHLAND PARK         ATTACHED W2’S
                                                                                                                                 INCOME TAX                    1
                                                                                                                                 P.O Box 239                    TAX PAID
                                                                                                                                 Eaton Rapids, MI 48827-0239   TOTALS FROM
                                                                                                                                 NUMBER OF                     REVERSE SIDE
                                                                                                                                 W-2’S SUBMITTED               2
    2023                                                                                                                                                        BALANCE
                                                                                                                                                                  DUE
                                                                                                                                                                PAY IN FULL
                                                                                                                                                               THIS RETURN
                         SIGNATURE                                                                                     PHONE #                                 3
                                                                                                                                                               OVERPAYMENT
                        TITLE                                                                                          DATE                                       ATTACH
                                                                                                                                                               EXPLANATION
                                                                                                                                                               4

                                                                                                                                                                     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:                                                  City                                                       Street                                                                                                                                            Moved out of Highland Park                                City                                                    Street                                               Name                                                                                          Business sold to:                       (Date)___________________________                       Wages will be paid starting                                        Still operating - Ceased paying wages.                                                                       (Date)___________________________                       Operations will be resumed on                                   Business permanently discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                                                                                                                              ____________________________                                                                                                                                                                                                                                           ____________________________
                                                                                                                                                                     __________________________                                                                                          __________________________                                                                                                                                                                                                                                          __________________________                           __________________________

                                                                                                                                                                     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:                                                  City                                                       Street                                                                                                                                            Moved out of Highland Park                                City                                                    Street                                               Name                                                                                          Business sold to:                       (Date)___________________________                       Wages will be paid starting                                        Still operating - Ceased paying wages.                                                                       (Date)___________________________                       Operations will be resumed on                                   Business permanently discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                                                                                                                              ____________________________                                                                                                                                                                                                                                           ____________________________
                                                                                                                                                                     __________________________                                                                                          __________________________                                                                                                                                                                                                                                          __________________________                           __________________________

                                                                                                                                                                     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:                                                  City                                                       Street                                                                                                                                            Moved out of Highland Park                                City                                                    Street                                               Name                                                                                          Business sold to:                       (Date)___________________________                       Wages will be paid starting                                        Still operating - Ceased paying wages.                                                                       (Date)___________________________                       Operations will be resumed on                                   Business permanently discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                                                                                                                              ____________________________                                                                                                                                                                                                                                           ____________________________
                                                                                                                                                                     __________________________                                                                                          __________________________                                                                                                                                                                                                                                          __________________________                           __________________________

                                                                                                                                                                     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:                                                  City                                                       Street                                                                                                                                            Moved out of Highland Park                                City                                                    Street                                               Name                                                                                          Business sold to:                       (Date)___________________________                       Wages will be paid starting                                        Still operating - Ceased paying wages.                                                                       (Date)___________________________                       Operations will be resumed on                                   Business permanently discontinued                                   Business permanently discontinued 
________________________________                                 ________________________________
                                                                                                                                                                                                                              ____________________________                                                                                                                                                                                                                                           ____________________________
                                                                                                                                                                     __________________________                                                                                          __________________________                                                                                                                                                                                                                                          __________________________                           __________________________

                                                                                                 _______________________                       QUARTER ENDED DEC. 31                            ____________________ DECEMBER                              ____________________ NOVEMBER                            ____________________ OCTOBER                       _______________________                       QUARTER ENDED SEPT 30                            ____________________ SEPTEMBER                             ____________________ AUGUST                            ____________________ JULY                           _______________________                       QUARTER ENDED JUNE 30                   ____________________ JUNE                               ____________________ MAY                          ____________________ APRIL                                                    _______________________                        QUARTER ENDED MARCH 31                                   ____________________ MARCH                          ____________________ FEBRUARY                                       ____________________ JANUARY                                        _______________________                                                                                    LIST PAYMENTS MADE WITH HP941/501

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            EMPLOYERS RETURNS.
        TOTAL PAID $                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SUMMARY

        ________

                                                                                                                                               $                                                                                                                                                                                                                                                                     $                                                                                                                                                                                                                                                                    $                                                                                                                                                                                                                                                                              $