Form Fr-900q - Employer/payor Withholding Tax - Quarterly Return - 2017

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DRAFT AS OF 06/08/16 - DO NOT FILE*
2017
FR-900Q Employer/Payor
Government of the
*17900Q710000*
District of Columbia
Withholding Tax - Quarterly Return
Important: Print in CAPITAL letters using black ink.
Vendor ID#0000
Federal Employer Identification Number
Account Number
OFFICIAL USE ONLY
Fill in
if Amended Return
Tax period ending (MMYY)
Name (not your trade name)
Report for this Quarter of 2017
Business mailing address #1
1. January, February, March
2. April, May, June
3. July, August, September
Business mailing address #2
4. October, November, December
City
State
Zip Code + 4
PART 1: DC Withholding Quarterly Return
1
1
$
DC Income Tax Withheld from wages, tips and other compensation..........
.
If monthly, complete the amount withheld for each month:
$
Month 1
.
$
.
Month 2
.
$
Month 3
.
2
Total withholding payments for this quarter, including overpayment applied from
$
.
prior quarters.....................................................................................
2
3
Balance Due: If Line 1 is greater than Line 2, subtract Line 2 from Line 1
$
and enter amount here.......................................................................
3
.
4
Overpayment: If Line 2 is greater than Line 1, subtract Line 1 from Line 2
$
and enter amount here........................................................................
.
4
Fill in only one:
Credit carry forward
Send a refund
PART 2: If your business has closed or you stopped paying wages, complete this part.
and enter the final date you paid wages
If your business has closed or you stopped paying wages, fill in here
(MMDDYYYY)
PART 3: Sign here.
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on information available to the preparer.
Daytime telephone number
Sign your name
Print your name
Date
Preparer's Tax Identification Number (PTIN)
Preparer’s signature
Preparer’s name
Date
and enter the name and phone number of that person. See instructions.
Third party designee To authorize another person to discuss this return with OTR, fill in here
Phone number
Designee’s name
2017 FR-900Q P1
Revised 05/16
Employer/Payor Withholding Tax page 1
This form is subject to change pending any forthcoming District Legislative or Administrative decisions and should not be used for filing purposes.
*

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