Form 941/c1- Me Loose - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2005 Page 3

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SCHEDULE 2/C1
(
) 2005
Loose
FORM 941/C1- ME Loose
00
Name:
Withholding
*0508522*
Account No.:
UC Employer Account No:
to
Period Covered:
MM
DD
YY
MM
DD
YY
Quarterly Income Tax Withholding and Unemployment Compensation Wages Listing
INCOME TAX
All employers designated SEASONAL by Department
WITHHOLDING
of Labor, see instructions for Column 16 on page 8.
Maine Income Tax
Payee Name (Last, First, MI)
Social Security Number
UC Gross Wages Paid
Withheld in the Quarter
14.
15.
16.
17.
$
,
$
,
-
-
.
.
a. __________________________________
$
,
$
,
-
-
.
.
b. __________________________________
$
,
$
,
-
-
.
.
c. __________________________________
$
,
$
,
-
-
.
.
d. __________________________________
$
,
$
,
-
-
.
.
e. __________________________________
$
,
$
,
-
-
.
.
f . __________________________________
$
,
$
,
-
-
.
.
g. __________________________________
$
,
$
,
-
-
.
.
h. __________________________________
$
,
$
,
-
-
.
.
i. __________________________________
$
,
$
,
-
-
.
.
j. __________________________________
$
,
$
,
-
-
.
.
k. __________________________________
$
,
$
,
-
-
.
.
l. __________________________________
$
,
$
,
-
-
.
.
m. _________________________________
$
,
$
,
-
-
.
.
n. __________________________________
$
,
$
,
-
-
.
.
o. __________________________________
$
,
$
,
-
-
.
.
p. __________________________________
$
,
$
,
-
-
.
.
q. __________________________________
$
,
$
,
-
-
.
.
r. __________________________________
$
,
$
,
-
-
.
.
s. __________________________________
$
,
$
,
-
-
.
.
t. __________________________________
$
,
$
,
-
-
.
.
u. __________________________________
$
,
$
,
-
-
.
.
v. __________________________________
$
,
$
,
-
-
.
.
w. __________________________________
$
,
,
$
,
,
.
.
18. Total on this page .............................................................. 18a.
18b.
$
,
,
$
,
,
.
.
19. Total for ALL pages .......................................................... 19a.
19b.

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