Form 941me - Employer'S Return Of Maine Income Tax Withholding printable pdf download

FORM 941ME

MAINE REVENUE SERVICES

Loose

2005

EMPLOYER’S RETURN

*0506220*

OF MAINE INCOME TAX WITHHOLDING

QUARTER #

Withholding Account Number:

Number of payees subject to

Maine income tax withholding.

1. Maine income tax withheld for this

Period Covered:

quarter (from Schedule 2, line 11) ... 1.

2. Less semi-weekly payments

(from Schedule 1, line 6) ................. 2.

Name and Address:

3a. Amount due with this return

(if line 1 minus line 2 is positive) 3a.

Name

3b. Overpayment to be refunded

(if line 1 minus line 2 is negative) 3b.

Street Address

Check this space if you are reporting Schedule 2 – Income

Tax Withholding Listing on MAGNETIC TAPE or DISKETTE ....

City

State

ZIP Code

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 _____________________

Contact person e-mail __________________________________ Paid preparer EIN:

Make check payable to:

Treasurer, State of Maine

Mail return and check to:

Maine Revenue Services, P.O. Box 1061, Augusta, ME 04332-1061

For the Third Quarter Only: please check any boxes that apply:

My return is prepared by a tax preparer and I do not need Maine tax forms and instructions mailed next year.

I would like personalized Schedule 2 – Income Tax Withholding Listing pages next year.

I would like non-personalized (blank) Schedule 2 – Income Tax Withholding Listing pages next year.

I would like no Schedule 2 – Income Tax Withholding Listing pages next year because I will submit Schedule 2 data by an approved

alternate method.

Cancellation Notice

4. Check here and complete this section if your business is discontinued or the requirement to withhold permanently ceases. .......................

Reason for cancellation ___________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Business sold to: ____________________________________________________________

Last Payroll Date:

M M

Address: ____________________________________________________________

____________________________________________________________

Date Sold:

M M

Telephone: ____________________________________________________________

Note: Use the Name and Address Change Form (Form 941/C1C-ME)

Office

on page 3 to change your business name or address.

use only

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

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