Form 5122 - City Income Tax E-File Payment Voucher - 2015 - Michigan Department Of Treasury
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1Instructions for Form 5122 - CITY-V
CITY Income Tax e-file Payment Voucher - 2015
Mail this form with payments for e-filed City of Detroit returns only. Do not file with your paper return.
Important Information
If you do not include penalty and interest with your
payment when required, Treasury will send you a bill for
Mail Form 5122, CITY Income Tax e-file Payment
the additional amount due.
Voucher (CITY-V) with your payment after you e-file
your City of Detroit Income Tax return.
Mailing Instructions
Do not use this voucher to make any other payments
• Make your check payable to the “State of Michigan
to the Michigan Department of Treasury.
- Detroit”. Print “2015 CITY-V” and the last four
If you do not owe any tax on your e-filed City of Detroit
digits of your Social Security number on the
Income Tax return, do not file this form.
check. If paying on behalf of another filer, write
the filer’s name and the last four digits of the filer’s
Enter on Form 5122 - CITY-V below the tax due as
Social Security number on the check. For accurate
shown on your:
processing of your payment, do not combine this
•
Form 5118, City of Detroit Resident Income Tax Return,
payment with any other payments.
line 22,
• Detach Form 5122 - CITY-V along the dotted line.
•
Form 5119, City of Detroit Nonresident Income Tax
• Do not attach your payment to Form 5122 - CITY-V.
Return, line 24, or
Place both items separately in the envelope and mail
Form 5120, City of Detroit Part-Year Resident Income
•
to:
Tax Return, line 41.
Michigan Department of Treasury
Your payment and Form 5122 - CITY-V are due
P.O. Box 30738
April 18, 2016. If you pay late, you must add penalty and
Lansing, MI 48909
interest to the amount due.
• Do not attach a copy of your return or payment to
Penalty accrues monthly at one percent of the tax due,
Form 5122 - CITY-V. Attaching either item will delay
and increases by an additional one percent per month, or
the application of payment to your account.
fraction thereof (e.g., penalty on a $500 tax due will be
$30 if the tax is unpaid for six months).
• Do not write notes on Form 5122 - CITY-V or submit
the voucher without payment.
The interest rate is 1 percent above the adjusted prime
If you have questions, you may call the Michigan
rate and is adjusted on January 1 and July 1 of each
Department of Treasury’s City Income Tax Section
year. Interest is charged from the original due date
at 517-636-5829. Assistance is also available using
of the return to the date the balance of the tax is paid.
TTY through the Michigan Relay Service by calling
The interest rate through June 30, 2016 is 4.25 percent
1-800-649-3777 or 711.
annually (.0001164 daily rate). For interest rates after
June 30, 2016 visit or call
Visit
for
additional
517-636-5829.
information.
Mail this form with payment for your e-filed city return. Do not file with your paper return.
Detach here and mail with your payment. Do not fold or staple the voucher.
Michigan Department of Treasury - City Tax Administration
Reset Form
5122 (09-15)
CITY-V
CITY Income Tax e-file Payment Voucher - 2015
Issued under authority of Public Act 284 of 1964, as amended. See instructions for filing guidelines.
Mail Form 5122 - CITY-V with your payment after you e-file your City Income Tax return.
Do not use this form to make any other payments to the State of Michigan.
Filer’s Name(s) (First Name, Middle Initial, Last Name)
Filer’s Full Social Security Number
Spouse’s Full Social Security Number
Payment for the City of:
City Code
Address (Street, City, State, ZIP Code)
DETROIT
170
WRITE PAYMENT
AMOUNT HERE
$
Make check payable to “State of Michigan
-
Detroit.” Write the last four digits of filer’s Social Security number and “2015 City-V” on the check.
Do not fold or staple. Mail to: Michigan Department of Treasury, P.O. Box 30738, Lansing, MI 48909.
+
0000 2015 105 01 27 9
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