Instructions For Form Sf-941 Employer'S Return Of Income Tax Withheld Page 2

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CLEAR FORM
SALE OR DISCONTINUANCE OF BUSINESS:
An employer who sells or discontinues business must file Notice of Change or Discontinuance. This form is included in
the employer packet that was mailed to you and is also available on the City’s website.
An employer who goes out of business or permanently ceases to be an employer must file W-2’s and SFW-3 by the date
the final withholding payment is due.
For your record of payments made
Paid under FEIN: _________________
Total W-2's issued: __________
Resident Employee’s
Non-Resident Employee’s
Period
# Emp.
Wages
Withheld
# Emp.
Wages
Withheld
Date paid
January
February
March
April
May
June
July
August
September
October
November
December
Total
Total
Resident
Non-Resident
Reconciliation Worksheet
Total Res. & Non Res.
__________
tax withheld
Total amount remitted
(Subtract)- __________
Amount due
= __________
Amount to be refunded $__________

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