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Form 941/c1 - Me Loose - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2006 Page 2

SCHEDULE 1/C1

(

) 2006

Loose

FORM 941/C1- ME Loose

Name:

*0608521*

Withholding Account No.:

UC Employer Account No:

Period Covered:

Reconciliation of 900ME Voucher Payments or Electronic Payments of Income Tax Withholding

For employers or non-payroll filers required to remit withholding taxes on a semiweekly basis (See instructions).

Date Wages or

Withholding

Payment

Date Wages or

Withholding

Payment

Date Wages or

Withholding

Payment

Non-wages Paid

Amount

Non-wages Paid

Amount

Non-wages Paid

Amount

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 (Should equal line 1) .......... $

Total (Enter here and on line 2) .... $

For the Third Quarter Only: all employers or non-payroll filers, please check if applicable:

I file my return electronically or my return is prepared by a tax preparer and I do not need Maine tax forms mailed to me next year.

For Field Advisor Use:

Form 941/c1 - Me Loose - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2006 Page 2