Mail remittance    CITY OF LAPEER
2020 L941 - CITY OF LAPEER INCOME TAX WITHHELD          and form to:       INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2020 1ST QTR             DUE ON   FEDERAL EMPLOYER ID #                    LAPEER MI  48446
1/1/20 TO 3/31/20        4/30/2020
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
2020 L941 - CITY OF LAPEER INCOME TAX WITHHELD          and form to:       INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2020 2ND QTR             DUE ON   FEDERAL EMPLOYER ID #                    LAPEER MI  48446
4/1/20 TO 6/30/20        7/31/2020
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
2020 L941 - CITY OF LAPEER INCOME TAX WITHHELD          and form to:       INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2020 3RD QTR             DUE ON   FEDERAL EMPLOYER ID #                    LAPEER MI  48446
7/1/20 TO 9/30/20        11/2/2020
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
2020 L941 - CITY OF LAPEER INCOME TAX WITHHELD          and form to:       INCOME TAX DEPT
                                                                           576 LIBERTY PARK
2020 4TH QTR             DUE ON   FEDERAL EMPLOYER ID #                    LAPEER MI  48446
10/1/20 TO 12/31/20      2/1/2021
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