Form 941p-Me - Pass-Through Entity Return Of Maine Income Tax Withheld From Members - 2016 Page 3

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SCHEDULE 3P (FORM 941P- ME) 2016
00
Name:
*16941P3*
Federal
Identifi cation
No.:
01 01 2016 - 12 31 2016
Period Covered:
List of Exempt Members - File with Form 941P- ME
13. Partner/Shareholder Name
14. Social Security Number (EIN if
15. Check Here
16. Distributive
17. Participating in
(Last, First, MI.)
other than an individual)
if EIN
Share %
Composite Return
.
%
a.
.
%
b.
.
%
c.
.
%
d.
.
%
e.
.
%
f.
.
%
g.
.
%
h.
.
%
i.
.
%
j.
.
%
k.
.
%
l.
.
%
m.
.
%
n.
.
%
o.
.
%
p.
.
%
q.
.
%
r.

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