Form L941p-Me - Pass-Through Entity Return Of Income Tax Withheld From Owners printable pdf download

FORM 941P- ME

MAINE REVENUE SERVICES

Loose

2005

PASS-THROUGH ENTITY RETURN

*0506250*

OF MAINE INCOME TAX WITHHELD FROM OWNERS

QUARTER #

Withholding Account Number:

Number of payees subject to

pass-through entity withholding.

1. Pass-through Entity Withholding for

Period Covered:

quarter (from Schedule 2, line 10) ... 1.

2. Less Prepayments

(from Schedule 1, line 5) ................. 2.

Name and Address:

3a. Amount due with this return

(if line 1 minus line 2 is positive) 3a.

Name

3b. Overpayment to be refunded

(if line 1 minus line 2 is negative) 3b.

Street Address

Check here if you are reporting Schedule 2P – Pass-through

Withholding Listing on MAGNETIC TAPE or DISKETTE ...........

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.

Date ___________ Signature ___________________________ Title _______________________________ Telephone _____________________

Contact person e-mail __________________________________ Paid preparer EIN:

Make check payable to:

Treasurer, State of Maine

Mail return and check to: Maine Revenue Services, P.O. Box 9118, Augusta, ME 04332-9118

For the Third Quarter Only: please check any boxes that apply:

My return is prepared by a tax preparer and I do not need Maine tax forms and instructions mailed next year.

I would like personalized Schedule 2P – Pass-through Entity Withholding Listing pages next year.

I would like non-personalized (blank) Schedule 2P – Pass-through Entity Withholding Listing pages next year.

I would like no Schedule 2P – Pass-through Entity Withholding Listing pages next year because I will submit Schedule 2P data by an

approved alternate method.

Cancellation Notice

4. Check here and complete this section if your business is discontinued or the requirement to withhold permanently ceases. .......................

Reason for cancellation ___________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Business sold to: ____________________________________________________________

Last Payroll Date:

M M

Address: ____________________________________________________________

____________________________________________________________

Date Sold:

M M

Telephone: ____________________________________________________________

Note: Use the Name and Address Change Form (Form 941P-ME)

Office

on page 3 to change your business name or address.

use only

Form L941p-Me - Pass-Through Entity Return Of Income Tax Withheld From Owners

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