Form 941a-Me - Amended Return Of Maine Income Tax Withholding

MAINE REVENUE SERVICES

FORM 941A-ME

2010

AMENDED RETURN

OF MAINE INCOME TAX WITHHOLDING

*1006320*

1 0

Period Covered:

Withholding originally

Withholding Account Number:

reported for the quarter ..............

Name and Address:

Correct withholding

for the quarter .............................

Amount of adjustment (+ or -)

Name

(see instructions) ........................

Underpayment to be paid

Address

(line 3 amount is negative) .........

Overpayment to be refunded

City

State

ZIP Code

(line 3 amount is positive) ...........

If this Form 941A-ME is received after the end of the tax year to which it applies, the section below must be completed. Please check each box that applies

and attach a detailed explanation of the adjustments and all supporting documentation to this return.

I certify that the overpayment on line 5 is not attributable to income taxes withheld from employees, payees or members.

I certify that payee statements (Forms W-2/W-2C or original/corrected 1099 statements) have been issued to employee(s), payee(s) or member(s)

as listed on Schedule 2A of Form 941A-ME, and I am enclosing copies of these forms to verify my refund request.

I am enclosing an amended Form W-3ME (Reconciliation of Maine Income Tax Withheld) to reﬂ ect changes made on Form 941A-ME.

_____________________________________________________________

6. Explanation of adjustments:

_________________________________________________________________________

_____________________________________________________________________________

____________________________________________________________________________

Note: Pursuant to 36 MRSA § 5276, if there is an overpayment of tax required to be deducted and withheld under § 5250, a refund shall be made

to the employer only to the extent that the overpayment was not deducted and withheld by the employer.

Under penalties of perjury, I certify that the information contained on this return and attachment(s) is true and correct, and that portion

of overpayment identiﬁ ed on line 5 attributable to over collected withholding tax for the current calendar year has been repaid to

employees and written statements have been obtained from each employee stating that the employee has not claimed and will not claim

a refund or credit of the amount of the over collection.

Signature:_______________________________________________________Title:______________________________________Date:__________________________

Print Name:________________________________________________Telephone: _____________________Contact person email:_______________________________

For Paid Preparers Only

Paid Preparer’s Signature:________________________________________________ Date:__________________ Telephone:__________________________________

Firm’s Name (or yours, if self-employed):_____________________________________

Paid Preparer EIN:

Maine Payroll Processor License Number:

Address:_______________________________________________________________

Make check payable to: Treasurer, State of Maine

Mail return and check (if applicable) to: Maine Revenue Services

P.O. Box 1061

Ofﬁ ce

PWD

Augusta, ME 04332-1061

use only

Form 941a-Me - Amended Return Of Maine Income Tax Withholding - 2010

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