Form 941c - Supporting Statement To Correct Information - 2006 Page 2
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Form 941c (Rev. 10-2006)
Page
Part IV
Medicare Tax Adjustment
(a)
(b)
(c)
(d)
Period Corrected (For quarterly
Wages and Tips
Correct Wages
Medicare Tax
returns, enter date quarter ended.
Previously Reported
and Tips for
Adjustment
For annual returns, enter year.)
for Period
Period
1
2
3
4
5
Totals. If more than one page, enter totals on first page only
6
Net Medicare tax adjustment. If more than one page, enter total of all columns (d) on first page
only. Enter here and on the appropriate line of the return with which you file this form
6
7
Net wage and tip adjustment. If more than one page, enter total of all lines 7 on first page only.
If line 5(c) is smaller than line 5(b), enter difference in parentheses
7
Part V
Explanation of Adjustments
941c
Form
(Rev. 10-2006)
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