Creator:
Date Created:
Place Created:
Keywords:Brent Fredrickson,Tracy Hall,federal tax return
Context:employer's quaretly federal tax return form
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Form 941 (Rev. July 1972) Department of the Treasury Internal Revenue Service
Employer's Quarterly Federal Tax Return
SCHEDULE A—Quarterly Report of Wages Taxable under the Federal Insurance Contributions Act—FOR SOCIAL SECURITY IF WAGES WERE NOT TAXABLE UNDER THE FICA MAKE NO ENTRIES IN ITEMS 1 THROUGH 9 AND 14 THROUGH 18
1. (First quarter only) Number of employees (except household) employed in the ■ pay period including March 12th ^ /	2. Total pages of this return including this page and / any pages of Form 941a /	3. Total number . of employees / listed /
List for each nonagricultural employee the WAGES taxable under the FICA which were paid during the quarter. If you pay an employee more		
than $9,000 in a calendar year report only the first $9,000 of such wages. In the case of "Tip Income" see instructions on page 4. Please report each employee's name and number exactly as shown on his Social Security card.
4. EMPLOYEE'S SOCIAL SECURITY NUMBER
5. NAME OP EMPLOYEE (Please typo or print)
6. TAXABLE FICA WAGES Paid to Employee in Quarter (Before deductions)
7. TAXABLE TIPS REPORTED (See page 4)
If amounts m column ere not tips
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Dollars Cents
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If you need mora apace for listing employees, use Schedule A continuation sheets. Form 941a. Totals for this page—Wage total in column 6 and tip total in column 7
8.	TOTAL WAGES TAXABLE UNDER FICA PAID DURING QUARTER.	. .
(Total of column 6 on this page and continuation sheets.) Enter here and in Item 14 below.....$................/..CJ.&..i..±..U........ jg§
9.	TOTAL TAXABLE TIPS REPORTED UNDER FICA DURING QUARTER. 'If no tips reported, write "None.")
(Total of column 7 on this page and continuation sheets.) Enter hare and In Item 15 below....................—$
Name............................................................................................................................ Date Quarter Ended
Address....................................................................................................................... Employer Identification No.............
IMPORTANT.—Keep this copy and a copy of each related schedule or statement.
Before filing the return be sure to enter on this copy your name, address, and identification number, and the period for which the return is filed.
10.	TOTAL WAGES AND TIPS SUBJECT TO WITHHOLDING PLUS OTHER COMPENSATION ■ . ■
11.	AMOUNT OF INCOME TAX WITHHELD FROM WAGES, TIPS, ANNUITIES, etc. (See Instructions)
12.	ADJUSTMENT FOR PRECEDING QUARTERS OF CALENDAR YEAR.........
13.	ADJUSTED TOTAL OF INCOME TAX WITHHELD...............
14.	TAXABLE FICA WAGES PAID (Item 8) .
15.	TAXABLE TIPS REPORTED (Item 9) . .
16.	TOTAL FICA TAXES (Item 14 plus Item 15)
17.	ADJUSTMENT (Sea instructions) . . .
18.	ADJUSTED TOTAL OF FICA TAXES . . .
19.	TOTAL TAXES (Item 13 plus Item 18).............................
20.	TOTAL DEPOSITS FOR QUARTER (INCLUDING FINAL DEPOSIT MADE FOR QUARTER) AND OVERPAYMENT FROM PREVIOUS QUARTER LIST IN SCHEDULE B. (See instructions on page 4).........................
Note: If undeposited taxes at the end of the quarter are $2C0 or more, the full amount must be deposited with an authorized commercial bank or a Federal Reserve bank. This deposit must be entered In Schedule B and included in item 20.
21.	UNDEPOSITED TAXES DUE (ITEM 19 LESS ITEM 20— THIS SHOULD BE LESS THAN $200). PAY TO INTERNAL REVENUE SERVICE AND ENTER HERE ...................................—>
22.	IF ITEM 20 IS MORE THAN ITEM 19, ENTER EXCESS HERE ► f	AND CHECK IF YOU WANT IT □ APPLIED TO NEXT RETURN. OR Q REFUNDED.
23. If not liable for returns In succeeding quarters write "FINAL" here ►
and enter date of final payment of taxable wages here ►
SEE "WHERE TO FILE" ON PAGE 2.
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