*010460000*
Name:
Withholding
Account No.:
Unemployment
Account No.
Period
010460000
Covered:
FORM 941/C1-ME
Unless designated a seasonal employer by the Department of Labor, enter all wages in Column 15 (Nonseasonal column).
All employers designated Seasonal, see instructions for Columns 15 and 16 on page 8.
Part Four - Unemployment Contribution Wage Listing
14. Social Security Number
15. Nonseasonal Wages Paid in Quarter 16. Seasonal Wages Paid in Quarter
17. Employee Name (Last, First, MI)
-
-
$
$
,
,
.
a.
.
-
-
,
,
b.
.
.
-
-
,
,
.
c.
.
-
-
,
,
.
d.
.
-
-
,
,
.
e.
.
-
-
,
,
.
f .
.
-
-
,
,
.
g.
.
-
-
,
,
.
h.
.
-
-
,
,
.
i.
.
-
-
,
,
.
j.
.
-
-
,
,
.
k.
.
-
-
,
,
.
l.
.
-
-
,
,
.
m.
.
-
-
,
,
.
n.
.
-
-
,
,
.
o.
.
-
-
,
,
.
p.
.
-
-
,
,
.
q.
.
-
-
,
,
r.
.
.
-
-
,
,
.
s.
.
-
-
,
,
.
t.
.
-
-
,
,
.
u.
.
-
-
,
,
.
v.
.
-
-
,
,
w.
.
.
$
,
,
.
18. Total wages listed on this page .............................................................................................................. 18
$
,
,
19. Total wages for ALL pages. Enter this total on line 6 in Part 2 and only on the last wage listing page .............. 19
.