Form 2769 - Computation Of Deposit Penalty

P a g e

o f ~

Form 2 7 6 9

(Rev. February 1987)

Taxpayer's Name

Department of the Treasury -- Internal Revenue Service

Computation of Deposit Penalty

Employer Identification No. Return Form Number

Tax Year

.,_,~

P =

- ~ . . E

c-

+~

8~

r -

o

Eighth

Monthly

1-3

Deposit Period Days

Amount of Deposit

Quarter

Monthly

Other

Required

Made

4-7

1-7

8-11

12-15

8-15

16-19

20-22

23-25

26-End

1-3

4-7

8-11

12-15

16-19

20-22

23-25

26-End

1-3

16-22

Semi-

Monthly

Monthly

"i'-15'

i

" i i ' ! i . . . .

23-End

16-End , 1-End

8-15

1-15 r~TI ~ '

16--22

23-End

16-End

1-End

4-7

I-7

8-11

iii ili !!~!

12-15

8-15

1-15

;

16-19

-

20-22

16-22

23-25

26-End

23-End

16-End

l-End

1-3

4-7

8-11

~

12-15

iT. :~

16-19

20-22

23-25

26-End

1-3

4-7

8-11

~

12-15

8~

o~:~

16-19

20-22

23-25

26-End

1-3

4-7

8-11

~}

12-15

~ ~i l i ~ ! ~ i i ! i i i ~ i ~ i ~ i l i i ! ! ~i ~i i ..... ~ ........... ~ ~! ~ ;i ~! !!i ! !!i ! ......... !iii ~ ~i ~i i ~ :i i i i ! i ~ i i i ~ i i r~i ~ i ~i i l ¸!

Underpym't.

or

Late Pym't.

First Quarter Total

Penalty

Percent

Amount

8-15

1-15

....

6-22

i ;i

23-End

16-End

1-End

1-7

8-15

1-15

!iii

ii ii!i :i : i : i : i : ~i

. E

O

23-End

16-End

1-End

i

,

1-7

:!i i i i i i i i ~ i i i ~ i i ~ i i i ! !!i ~ i ! i ! i i i ! ~!~i ~ i ~ i i i ~ i i ~ .~!~!i i i T i i i ~ i ! i ~ i i i i i ~ i ~ i i i i i ~ i i i i i i ~ i i ! !~i ~ i i ! i i ! i i i i i ~

i ~ i i i ~ i i i ~ i i i ~ i ~ i i i ~ i ~ !i ! ~i ~ i ! ~!~!i ! i ! !!!~!!!i ! i i ! ~i i i ! !!i i i i i ! i i ~ i ~ !!i ! i ~ !i ! i i i i i ~ i i / i i i i ! i i i ! i i i i ! i ! i i i i i i i i i i ~ i i i ! !i i i i ! !i i ~ i i i ~ !i ! i i

8-15

1-15

~i~i:ii:~ili!!ii!iiiiiiiil;iiiii!iiiii:!i:iii:;i:i

16-19

i;ii;!iiiiil;iiiiii!iii!iii!!!ii!

i ! !i ! i ! ili iiil iiiiiiiiiii:i;i ;i l i l i i i i ; i ~ i ; i l i ~ i i i ! !i i i i i ! !i ; !;i i !

i!!iii(iiiii(i!!ii!iiiiiiii!iiiii(iii!

iii iiiii!i!i;i

20-End

23-End

16-End

1-End

I

. . . . . . .

I

Second

Quarter Total

Cat. No. 188780

Form 2769 r~Rev 2-87~