Form Nj-941-X - Amended Quarterly Return Of Gross Income Tax Withheld

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State of New Jersey - Division of Taxation
NJ-941-X
Amended Quarterly Return of Gross Income Tax Withheld
Use for Reporting Quarter 09/97 and After
Reporting Quarter:
Applied Date:
Mo.
Yr.
Mo.
Day
Yr.
$
.
Month 1 . . . . . . . . . .
-
-
/
Identification Number
$
.
Month 2 . . . . . . . . . .
___________________________________________________________
Name
$
.
Month 3 . . . . . . . . . .
___________________________________________________________
Trade Name (If applicable)
___________________________________________________________
Total Liability
$
.
Address
for Quarter . . . . . . . . . .
___________________________________________________________
Less:
City
State
Zip Code
Payments
$
.
for Quarter . . . . . . . . . .
State of New Jersey-GIT
Make Check Payable To:
Overpayment
(check one)
This form must be completed in its entirety, as amended.
$
.
Refund ¨
Credit ¨
$
.
Amount to Pay . . . . . . .

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