Creator:Tracy Hall
Date Created:March 31, 1977
Place Created:Provo, Utah
Keywords:Tracy Hall,employer's federal tax return
Context:employer's quarterly federal tax return form
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	Form 941 (Rev. Jan. 1977) 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 List for each nonagricultural employee the WAGES taxable under the FICA which were paid during the quarter. If you pay an employee more than $16,500 in a calendar year, report only the first $16,500 of such wages. In the case of "Tip Income," see instructions on page 4. IF WAGES WERE NOT TAXABLE UNDER THE FICA, MAKE NO ENTRIES IN ITEMS 1 THROUGH 9 AND 14 THROUGH 18.					
1. Total pages of this return including this page and any pages of Form 941a ►		2. Total number of employees listed ^		3. (First quarter only) Number of employees (except household) employed in the pay period including March 12th	
4. EMPLOYEE'S SOCIAL SECURITY NUMBER
5. NAME OF EMPLOYEE (Please type or print)
6. TAXABLE FICA WAGES Paid to Employee in Quarter (Before Deductions) Dollars	Cents
7. TAXABLE TIPS
REPORTED (See page 4) Dollars Cents
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If you need more space for listing employees, use Schedule A continuation sheets, Form 941a.
Totals for this page—Wage total in column 6 and tip total in column 7 -
8.	TOTAL WAGES TAXABLE UNDER FICA PAID DURING QUARTER. _$_
(Total of column 6 on this page and continuation sheets.) Enter here and in item 14 below.
9.	TOTAL TAXABLE TIPS REPORTED UNDER FICA DURING QUARTER.
(Total of column 7 on this page and continuation sheets.) Enter here and in item 15 below. (If no tips reported, write "None.")
Name
Date Quarter Ended.
Address ...................................................................................... Employer Identification No...__T..........
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.	Total Income Tax Withheld From Wages, Tips, Annuities, Gambling, 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 (See instructions) ....
18.	Adjusted Total Of FICA Taxes ....
. multiplied by 11.7% > multiplied by 5.85% =
=TAX =TAX
19. Total Taxes (Item 13 plus Item 18)...................
20 TOTAL DEPOSITS FOR QUARTER (INCLUDING FINAL DEPOSIT MADE FOR QUARTER) AND OVERPAYMENT FROM PREVIOUS QUARTER LISTED IN SCHEDULE B (See instructions on page 4).......
Note: If undeposited taxes at the end of the quarter are $200 or more, the lull amount must be deposited with an authorized commercial bank or a Federal Reserve bank in accordance with instructions on the reverse of the Federal tax deposit form 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 ► $_And Check If You Want It □ Applied to Next Return, Or □ Refunded.
23. If not liable for returns in the future, write "FINAL" (See instructions)
Date final wages paid ►
See "Where to File" on Page 2.
218-245-1