1. Last pay period on which Highland Park
taxes were withheld__________________
2. Check reason for “Final Return” and answer
applicable questions:
Business permanently discontinued
Business permanently discontinued
Operations will be resumed on
(Date)___________________________
Still operating - Ceased paying wages.
Wages will be paid starting
(Date)___________________________
Business sold to:
Name __________________________
Street __________________________
City ____________________________
Moved out of Highland Park
3. Your current address:
Street __________________________
City ____________________________
4. Other: __________________________
________________________________
________________________________
1. Last pay period on which Highland Park
taxes were withheld__________________
2. Check reason for “Final Return” and answer
applicable questions:
Business permanently discontinued
Business permanently discontinued
Operations will be resumed on
(Date)___________________________
Still operating - Ceased paying wages.
Wages will be paid starting
(Date)___________________________
Business sold to:
Name __________________________
Street __________________________
City ____________________________
Moved out of Highland Park
3. Your current address:
Street __________________________
City ____________________________
4. Other: __________________________
________________________________
________________________________
1. Last pay period on which Highland Park
taxes were withheld__________________
2. Check reason for “Final Return” and answer
applicable questions:
Business permanently discontinued
Business permanently discontinued
Operations will be resumed on
(Date)___________________________
Still operating - Ceased paying wages.
Wages will be paid starting
(Date)___________________________
Business sold to:
Name __________________________
Street __________________________
City ____________________________
Moved out of Highland Park
3. Your current address:
Street __________________________
City ____________________________
4. Other: __________________________
________________________________
________________________________
1. Last pay period on which Highland Park
taxes were withheld__________________
2. Check reason for “Final Return” and answer
applicable questions:
Business permanently discontinued
Business permanently discontinued
Operations will be resumed on
(Date)___________________________
Still operating - Ceased paying wages.
Wages will be paid starting
(Date)___________________________
Business sold to:
Name __________________________
Street __________________________
City ____________________________
Moved out of Highland Park
3. Your current address:
Street __________________________
City ____________________________
4. Other: __________________________
________________________________
________________________________
_______________________
JANUARY
____________________
FEBRUARY
____________________
MARCH
____________________
QUARTER ENDED MARCH 31 $
_______________________
APRIL
____________________
MAY
____________________
JUNE
____________________
QUARTER ENDED JUNE 30 $
_______________________
JULY
____________________
AUGUST
____________________
SEPTEMBER
____________________
QUARTER ENDED SEPT 30 $
_______________________
OCTOBER
____________________
NOVEMBER
____________________
DECEMBER
____________________
QUARTER ENDED DEC. 31 $
_______________________
TOTAL PAID $ ________
SUMMARY
LIST PAYMENTS MADE WITH HP941/501
EMPLOYERS RETURNS.