Form 941/c1-Me - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2011 Page 2

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SCHEDULE 1/C1 (FORM 941/C1- ME) 2011
99
Name:
Withholding
-
*1108521*
Account No.:
UC Employer
Account No:
2 0 1 1
2 0 1 1
-
/
/
/
/ -
-
Period Covered:
MM
DD
YY YY
MM
DD
YYYY
Reconciliation of Semiweekly Payments of Income Tax Withholding
For employers or non-payroll fi lers required to remit withholding taxes on a semiweekly basis (see instructions).
Date Wages
Date Wages
Date Wages
Withholding
Payment
Withholding
Payment
Withholding
Payment
or Non-wages
or Non-wages
or Non-wages
Amount
Amount
Amount
Amount
Amount
Amount
Paid
Paid
Paid
Subtotal A
Subtotal B
Subtotal C
12. Withholding Amount this Quarter
13. Payment Amount this Quarter
Subtotal A.......................................$
,
,
.
,
,
.
Subtotal A.......................................$
Subtotal B ......................................$
,
,
.
,
,
.
Subtotal B ......................................$
Subtotal C ......................................$
,
,
.
Subtotal C ......................................$
,
,
.
Total (Enter on Form 941/C1-ME,
,
,
.
,
,
.
Total ..............................................$
line 2) .............................................$
For Field Advisor Use: ___________________________________________________

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