Form Fr-900a - Employer/payor Withholding Tax - Annual Return

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

2013

FR-900A

l p

y o

r e

P /

y a

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*139000110002*

Government of the

Withholding Tax – Annual Return

District of Columbia

Important: Print in CAPITAL letters using b



Taxpayer Identiﬁcation Number

Account Number

Fill in

if FEIN

Clear

Tax Period Ending (MMYY)

OFFICIAL USE ONLY

Fill in

if final return

Fill in

if SSN

Vendor ID#0002

Fill in

if amended return

Business name

Due Date

1. DC income tax withheld

Business mailing address line 1

this year per W-2

2. DC income tax withheld

this year per 1099

Business mailing address line 2

3. Total income tax withheld

0.00

this year

City

State

Zip Code +4

Telephone number of person to contact

Preparer’s PTIN

Under penalties of law, I declare that, to the best of my knowledge, this return is correct. Declaration of paid preparer is based on the information available to the preparer.



Taxpayer’s signature

Title

Date

Paid Preparer’s Signature

Date

2013 FR-900A