Form Fr-900a - Employer Withholding Tax - Annual Return - 2005

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2005 FR-900A Employer Withholding
Government of the
*059000110000*
District of Columbia
Tax — Annual Return
Taxpayer Identifi cation Number
Fill in
if you will not be
Fill in
if FEIN
l
required to fi le this return again.
OFFICIAL USE ONLY
Fill in
if SSN
Business name
.
$
DC income tax withheld
00
Fill in
if this is your fi rst return or if your address changed from your last return
this year (dollars only)
Mailing address line 1
Due Date
Account Number (provided by OTR)
Mailing address line 2
1/20/2006
Telephone number of person to contact
Preparer’s FEIN, SSN or PTIN
State
Zip Code
City
Under penalties of law, I declare that, to the best of my knowledge, this return is correct. Declaration of paid preparer is based on all the
information available to the preparer.
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Taxpayer’s signature
Title
Date
Paid Preparer’s Signature
Date
2005 FR-900A P1

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