Mail remittance   CITY OF LAPEER
2023 L941 - CITY OF LAPEER INCOME TAX WITHHELD           and form to:      INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2023 1ST QTR             DUE ON    FEDERAL EMPLOYER ID #                   LAPEER MI  48446
1/1/23 TO 3/31/23        5/1/2023
Business Name & Address:                                      FINAL PAYMENT-SEE BACK

                                               Tax Withheld This Quarter   $
                                               Prior Tax Paid This Quarter $
                                               Total Tax Amount Due        $

Signature                          Title                 Date              Phone Number

                                                         Mail remittance   CITY OF LAPEER
2023 L941 - CITY OF LAPEER INCOME TAX WITHHELD           and form to:      INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2023 2ND QTR             DUE ON    FEDERAL EMPLOYER ID #                   LAPEER MI  48446
4/1/23 TO 6/30/23        7/31/2023
Business Name & Address:                                      FINAL PAYMENT-SEE BACK

                                               Tax Withheld This Quarter   $
                                               Prior Tax Paid This Quarter $
                                               Total Tax Amount Due        $

Signature                          Title                 Date              Phone Number

                                                         Mail remittance   CITY OF LAPEER
2023 L941 - CITY OF LAPEER INCOME TAX WITHHELD           and form to:      INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2023 3RD QTR             DUE ON    FEDERAL EMPLOYER ID #                   LAPEER MI  48446
7/1/23 TO 9/30/23        10/31/2023
Business Name & Address:                                      FINAL PAYMENT-SEE BACK

                                               Tax Withheld This Quarter   $
                                               Prior Tax Paid This Quarter $
                                               Total Tax Amount Due        $

Signature                          Title                 Date              Phone Number

                                                         Mail remittance   CITY OF LAPEER
2023 L941 - CITY OF LAPEER INCOME TAX WITHHELD           and form to:      INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2023 4TH QTR             DUE ON    FEDERAL EMPLOYER ID #                   LAPEER MI  48446
10/1/23 TO 12/31/23      1/31/2024
Business Name & Address:                                      FINAL PAYMENT-SEE BACK

                                               Tax Withheld This Quarter   $
                                               Prior Tax Paid This Quarter $
                                               Total Tax Amount Due        $

Signature                          Title                 Date              Phone Number