Form 941me - Employer'S Return Of Maine Income Tax Withheld - 2003

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*030620000*
MAINE
REVENUE SERVICES
FORM 941ME
030620000
EMPLOYER’S RETURN OF MAINE INCOME TAX WITHHELD
QUARTER #
1
NOTE: PLEASE COMPLETE THE BACK OF THIS FORM
Due on or Before:
Withholding Account Number:
$
,
,
.
04-30-03
1. Maine income tax withheld for this quarter .... 1
01-234567890
2. Less semi-weekly payments
$
Period Covered:
,
,
.
(from Schedule 1, line 5 below) ..................... 2
01-01-03 - 03-31-03
$
,
,
3. Amount due with this return ........................... 3
.
Name:
MADE UP NAME CORPORATION INC
JOHN DOE
Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.
Date _____________ Signature ________________________________ Title _____________________________________ Telephone _________________________
Schedule 1
Reconciliation of 900ME Voucher Payments or EFT Payments of Income Tax Withholding
For employers required to remit withholding taxes on a semi-weekly basis (see instructions).
Date Wages
Amount
Check
Date Wages
Amount
Check
Date Wages
Amount
Check
Paid
Withheld
Amount
Paid
Withheld
Amount
Paid
Withheld
Amount
4. Total withholding this quarter (Enter here and on line 1 above)
5. Total Semi-weekly payments remitted this quarter (Enter here and on line 2 above)
$
$
,
,
,
,
.
.
CANCELLATION NOTICE
6. Check this box and complete the following section if your
business is discontinued or payment of wages permanently ceases.
FINAL
Make check payable to:
Treasurer, State of Maine
Reason for cancellation ____________________________________________________________________________
Mail to:
Maine Revenue Services
-
-
Last Payroll Date:
Business Sold to: __________________________________________
P.O. Box 1061
Augusta, ME 04332-1061
Mo.
Day
Year
(address): ________________________________________________
Date Sold: _____________________________ Telephone: ________________________________________________
Office use only
Note: Use the Name and Address Change Form (Form 941/C1C-ME) on page 3 to change your business name or address.

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