Form 941p-Me - Pass-Through Entity Return Of Maine Income Tax Withheld From Members - 2009

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FORM 941P-ME
MAINE REVENUE SERVICES
2009
00
PASS-THROUGH ENTITY RETURN
*09062L0*
OF MAINE INCOME TAX WITHHELD FROM MEMBERS
QUARTER #
-
-
-
Due on or Before:
Pass-through Withholding Account Number:
A. Number of payees subject to
,
pass-through entity withholding. ............
Period Covered:
-
-
to
-
-
1.
Pass-through entity withholding for this
.
MM
DD
YY
MM
DD
YY
,
,
$
quarter (from Schedule 2P, line 10) .....1.
Name and Address:
2.
Less payments (from Schedule 1P, line
$
.
,
,
5) .........................................................2.
Name
3a. Amount due with this return (if line 1
$
.
,
,
is greater than line 2) .........................3a.
Address
3b. Overpayment to be refunded (if line 2
.
$
,
,
is greater than line 1) .........................3b.
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.
Signature:________________________________________________ __________________________________
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:_______________________________________________________________
Note: Use the Business Notifi cation Change Form (Form 941BN-ME) on page 3 to change your business name or address.
Make check payable to:
Treasurer, State of Maine
See Page 6 for Electronic Filing and Payment Requirements and Options
Mail return and check to:
Maine Revenue Services
P.O. Box 9118 Augusta,
ME 04332-9118
Offi ce use only
PWD

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