DIVISION OF REVENUE AND TAXATION
COMMONWEALTH GOVERNMENT OF THE NORTHERN MARIANA ISLANDS
EMPLOYER’S QUARTERLY WITHHOLDING TAX RETURN
Do not write in this space - DLN
Do not write in this space - Date filed
THIS IS A MACHINE READABLE FORM
PLEASE TYPE OR PRINT IN INK IN CAPITAL LETTERS
A.1. Taxpayer’s Name
C. Taxpayer’s Identification Number (TIN)
F. MARK HERE IF THIS IS A FINAL
RETURN AND INDICATE THE DATE
WHEN BUSINESS WAS CLOSED OR
A.2. Doing Business As
DISSOLVED
D. Quarter Ended
B.
Mailing Address
QUARTER
Y
E
A
R
E. Telephone Number (s)
:
MONTH
D A Y
Y E A R
CHECK IF
AMENDED
CONSOLIDATED
ORIGINAL
H. Total wages paid this quarter
G. Did you file a withholding tax return for the last quarter?
Yes
No
If “NO”, explain
$
Total number of employees this quarter
FOR OFFICIAL
COMPUTATION OF CNMI WAGE AND SALARY AND NMTIT TAXES
COLUMN A
COLUMN B
USE ONLY
I. 1.a. TOTAL 4CMC Division 1 Chapter 2 taxes withheld
b.
Less amount previously paid (line F.1 of Form 500 - WH)
c.
Less amount previously paid (Form OS-3705, if amending or consolidating)
d.
Balance (Chapter 2 taxes withheld) due this quarter (line I.1a minus lines I.1b and I.1c
2.a.
Total 4CMC Div. 1 Chapter 7 taxes computed $ ________________taxes withheld
b. Less amount previously paid (line F.2 of FORM 500 - WH)
c.
Less amount previously paid (FORM OS-3705, if amending or consolidating)
d. Balance (Chapter 7) due this quarter (line I.2a minus lines I.2b and I.2c)
J. 1. PENALTY CHARGES:
(a) Failure to file
(Chapter 2)
(b) Failure to file
(Chapter 7)
(c) Failure to pay
(Chapter 2)
(d) Failure to pay
(Chapter 7)
2. INTEREST CHARGES:
(a) Interest charge (Chapter 2)
(b) Interest charge (Chapter 7)
K. Total Due (add amounts in Column B)
PAY THIS AMOUNT
L. DECLARATION: Under the penalties of perjury, I declare that this return is, to the best of my knowledge and belief, true and correct.
Name (Typed) and Signature
Title
Date
Preparer’s Signature:
Date:
Preparer’s SSN:
TIN:
PAID
PREPARER’S
Firm’s Name
Mailing address:
USE ONLY
FOR OFFICIAL USE ONLY
DATE PAID:
RECEIPT NO.:
AMOUNT:
RECEIVED BY:
NOTE: This revision is effective 2nd Quarter 2010
Form OS-3705 (Rev. 6/2010)