Form J 941-501 - Jackson Income Tax Withheld - 2015 Page 2

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SUMMARY
1. Last pay period on which Jackson Taxes
1. Last pay period on which Jackson Taxes
1. Last pay period on which Jackson Taxes
1. Last pay period on which Jackson Taxes
LIST PAYMENTS MADE WITH J941/501
were withheld _______________________
were withheld _______________________
were withheld _______________________
were withheld _______________________
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
2. Check reason for “Final Return” and answer
EMPLOYERS RETURNS.
_________________________
applicable questions:
applicable questions:
applicable questions:
applicable questions:
JANUARY
____________________
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
Business permanently discontinued
____________________
FEBRUARY
Business temporarily discontinued
Business temporarily discontinued
Business temporarily discontinued
Business temporarily discontinued
MARCH
____________________
Operations will be resumed on
Operations will be resumed on
Operations will be resumed on
Operations will be resumed on
____________________
QUARTER ENDED MARCH 31 $
(Date)___________________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
. . . . . . . . . . . . . . . . .
APRIL
____________________
Still operating - Ceased paying wages.
Still operating - Ceased paying wages.
Still operating - Ceased paying wages.
Still operating - Ceased paying wages.
MAY
____________________
Wages will be paid starting
Wages will be paid starting
Wages will be paid starting
Wages will be paid starting
JUNE
____________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
(Date)___________________________
QUARTER ENDED JUNE 30
$
____________________
Business sold to:
Business sold to:
Business sold to:
Business sold to:
. . . . . . . . . . . . . . . . .
JULY
____________________
Name __________________________
Name __________________________
Name __________________________
Name __________________________
AUGUST
____________________
Street __________________________
Street __________________________
Street __________________________
Street __________________________
SEPTEMBER
____________________
City ____________________________
City ____________________________
City ____________________________
City ____________________________
____________________
QUARTER ENDED SEPT. 30
$
Moved out of Jackson
Moved out of Jackson
Moved out of Jackson
Moved out of Jackson
. . . . . . . . . . . . . . . . .
OCTOBER
____________________
3. Your current address:
3. Your current address:
3. Your current address:
3. Your current address:
____________________
NOVEMBER
Street __________________________
Street __________________________
Street __________________________
Street __________________________
DECEMBER
____________________
City ____________________________
City ____________________________
City ____________________________
City ____________________________
____________________
QUARTER ENDED DEC. 31
$
4.
Other: __________________________
4.
Other: __________________________
4.
Other: __________________________
4.
Other: __________________________
. . . . . . . . . . . . . . . . .
________________________________
________________________________
________________________________
________________________________
TOTAL PAID $ ___________
________________________________
________________________________
________________________________
________________________________

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