Form 941 - Employer'S Quarterly Federal Tax Return - 2010

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941 for 2010:
950110
Employer’s QUARTERLY Federal Tax Return
Form
OMB No. 1545-0029
(Rev. February 2010)
Department of the Treasury — Internal Revenue Service
(EIN)
Report for this Quarter of 2010
Employer identification number
(Check one.)
Name (not your trade name)
1: January, February, March
Trade name (if any)
2: April, May, June
3: July, August, September
Address
Number
Street
Suite or room number
4: October, November, December
City
State
ZIP code
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1: Answer these questions for this quarter.
1
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), Dec. 12 (Quarter 4)
1
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2
Wages, tips, and other compensation
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2
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3
Income tax withheld from wages, tips, and other compensation .
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3
Check and go to line 6.
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
5
Taxable social security and Medicare wages and tips:
Column 1
Column 2
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5a Taxable social security wages
.124 =
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5b Taxable social security tips
.124 =
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.029 =
5c
Taxable Medicare wages & tips
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5d Total social security and Medicare taxes
(Column 2, lines 5a + 5b + 5c = line 5d) .
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5d
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(lines 3 + 5d = line 6)
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6
Total taxes before adjustments
6
7
CURRENT QUARTER’S ADJUSTMENTS, for example, a fractions of cents adjustment.
See the instructions.
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7a Current quarter’s fractions of cents .
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7b Current quarter’s sick pay
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7c
Current quarter’s adjustments for tips and group-term life insurance
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7d TOTAL ADJUSTMENTS. Combine all amounts on lines 7a through 7c .
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7d
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8
Total taxes after adjustments. Combine lines 6 and 7d
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8
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9
Advance earned income credit (EIC) payments made to employees .
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9
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(line 8 – line 9 = line 10) .
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10
Total taxes after adjustment for advance EIC
10
11
Total deposits for this quarter, including overpayment applied
from a prior quarter and overpayment applied from Form 941-X or
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Form 944-X .
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12a
COBRA premium assistance payments (see instructions)
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Number of individuals provided COBRA premium
12b
assistance reported on line 12a
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13
Add lines 11 and 12a .
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13
If line 10 is more than line 13, write the difference here.
14
Balance due.
For information on
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how to pay, see the instructions
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14
Apply to next return.
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15
Overpayment. If line 13 is more than line 10, write the difference here
Check one
Send a refund.
Next
You MUST complete both pages of Form 941 and SIGN it.
941
Form
(Rev. 2-2010)
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 17001Z

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