Form H-501 - Hamtramck Income Tax Withheld Page 2

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1. Last pay period on which Hamtramck
1. Last pay period on which Hamtramck
1. Last pay period on which Hamtramck
taxes were withheld__________________
taxes were withheld__________________
taxes were withheld__________________
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
applicable questions:
applicable questions:
applicable questions:
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Operations will be resumed on
Operations will be resumed on
Operations will be resumed on
(Date)___________________________
(Date)___________________________
(Date)___________________________
Still operating - Ceased paying wages.
Still operating - Ceased paying wages.
Still operating - Ceased paying wages.
Wages will be paid starting
Wages will be paid starting
Wages will be paid starting
(Date)___________________________
(Date)___________________________
(Date)___________________________
Business sold to:
Business sold to:
Business sold to:
Name __________________________
Name __________________________
Name __________________________
Street __________________________
Street __________________________
Street __________________________
City ____________________________
City ____________________________
City ____________________________
Moved out of Hamtramck
Moved out of Hamtramck
Moved out of Hdamtramck
3. Your current address:
3. Your current address:
3. Your current address:
Street __________________________
Street __________________________
Street __________________________
City ____________________________
City ____________________________
City ____________________________
4.
Other: __________________________
4.
Other: __________________________
4.
Other: __________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

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Parent category: Financial
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