Form F-Ss-4 - Income Tax Division Employer'S Withholding Registration

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F-SS-4 City of Flint Income Tax Division Employer’s Withholding Registration
Complete this registration form if required to withhold or voluntarily withholding and:
1) Started a new business 2) Purchased an ongoing business 3) Started doing business in the City of
Flint 4) Changed the type of business ownership (e.g. from sole proprietorship to partnership,
incorporating a sole proprietorship or partnership)
Employers that are required to register and withhold:
1) Employers having a location in the City of Flint 2) Employers doing business in the City of Flint,
even though they are not located in the City.
Withhold Tax from Wages Paid to the Following Employees:
1) All residents of the City of Flint whether or not they work in the City 2) All non-residents who work in
the City of Flint. Withhold only on wages earned in the City of Flint
Online Withholding Site for Flint:
City of Flint Income Tax Dept., Attn: Withholding Section, PO Box 529, Eaton Rapids, MI 48827-0529
Mail to:
(517) 663-6141 City of Flint Income Tax Dept. Attn: Withholding Section
Fax to:
Attn: Withholding Section
Email to:
Employer’s Federal Identification Number
1. TRADE NAME:
2. OWNER’S NAME: (IF DIFFERENT FROM TRADE NAME)
3. MAIN OFFICE MAILING ADDRESS:
4. FLINT ADDRESS:
5. (CHECK TYPE OF ORGANIZATION)
6. LOCAL TELEPHONE #
7. EMAIL ADDRESS
SOLE PROPERITOR
PARTNERSHIP
CORPORATION
OTHER
7. NO. EMPLOYEES
8. ACCOUNTING PERIOD
CALENDAR YEAR
FISCAL YEAR ENDING
10. GIVE THE DATE THE BUSINESS WAS ACQUIRED BY CURRENT
9. IF THIS BUSINESS WAS PREVIOUSLY OWNED BY ANOTHER EMPLOYER PRINT NAME BELOW:
EMPLOYER
SIGNATURE
TITLE
DATE
For more information email
or call the Income Tax Division at
(810) 766-7015. You can also refer to the Income Tax Ordinance, Income Tax Withholding
guide at

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