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Form 941/c1-Me - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2007 Page 2

SCHEDULE 1/C1 (FORM 941/C1- ME Loose) 2007

Name:

*0708521*

Withholding

Account No.:

UC Employer

Account No:

Period Covered:

Reconciliation of 900ME Voucher Payments or Electronic Payments of Income Tax Withholding

For employers or non-payroll ﬁ lers required to remit withholding taxes on a semiweekly basis (see instructions).

Date Wages

Withholding

Payment

Withholding

Payment

Withholding

Payment

or Non-wages

Amount

Paid

Subtotal A

Subtotal B

Subtotal C

12. Withholding Amount this Quarter

13. Payment Amount this Quarter

Subtotal A ......................................$

Subtotal B ......................................$

Subtotal C ......................................$

Total (Enter on Form 941/C1-ME,

line 2) .............................................$

line 1) .............................................$

For the Third Quarter Only: all employers or non-payroll ﬁ lers, please check if applicable:

I ﬁ le my return electronically or my return is prepared by a tax preparer and I do not need Maine tax forms mailed to me next year.

For Field Advisor Use: ___________________________________________________

Form 941/c1-Me - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2007 Page 2