Form: Os-3705 - Employer'S Quarterly Withholding Tax Return

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DIVISION OF REVENUE AND TAXATION
COMMONWEALTH GOVERNMENT OF THE NORTHERN MARIANA ISLANDS
EMPLOYER’S QUARTERLY WITHHOLDING TAX RETURN
20
DLN
Page
of
(Please type or print in ink)
(See reverse side of this form for instructions)
A. 1. Taxpayer’s Name
C. 1. Taxpayer’s Identification Number
F.
MARK HERE IF THIS
IS A FINAL RETURN AND
INDICATE
THE
DATE
A. 2. Doing Business As
C. 2. Identification No. Used Previous Quarter
WHEN BUSINESS WAS
.
CLOSED OR DISSOLVED
“
B. Mailing Address
D. Quarter Ended
G
G
G
ORIGINAL
AMENDED
CONSOLIDATED
)
CHECK IF:
E. Telephone Number(s
DATE
“
“
G. Did you file a withholding tax return for the last quarter?
Yes
No
H.
Number of employees
If “No”, explain
reported on this return
I.
Number
of
pages
attached
FOR OFFICIAL
COMPUTATION OF CNMI WAGE AND SALARY AND NMTIT TAXES
COL. A
COL. B
USE ONLY
*
J. 1. a. Total 4 CMC Div. 1 Chp. 2 taxes withheld (from Col. G of FORM: OS-3705A)
*
b. Less amount previously paid (line F. 1 of FORM 500 - WH)
*
c. Less amount previously paid (Form OS-3705, if amending or consolidating)
*
d. Balance (Chp. 2 taxes withheld) due this quarter (line J.1a minus lines J.1b and J.1c)
*
2. a. Total 4 CMC Div. 1 Chp. 7 taxes withheld (from Col. H of FORM: OS-3705A).
*
b. Less amount previously paid (line F. 2 of FORM 500 - WH)
*
c. Less amount previously paid ( FORM OS-3705, if amending or consolidating)
*
d. Balance (Chp. 7) due this quarter (line J.2a minus lines J.2b and J.2c)
*
K. 1. PENALTY CHARGES:
(a) Failure to File
( Chapter 2)
*
(b) Failure to File
( Chapter 7)
*
(c) Failure to Pay
(Chapter 2)
*
(d) Failure to Pay
(Chapter 7)
*
2. INTEREST CHARGES:
(a) Interest Charge
(Chapter 2)
*
(b) Interest Charge
(Chapter 7)
*
PAY THIS AMOUNT
L. Total Due (Add amounts in Col. B)
. DECLARATION: Under the penalties of perjury, I declare that this return is, to the best of my knowledge and belief, true and correct.
M
Name (Typed) and Signature
Title
Date
PAID
Preparer’s Signature:
Date:
Preparer’s SSN:
TIN:
PREPARER’S
USE ONLY
Firm’s Name:
Mailing Address:
FOR OFFICIAL USE ONLY
Account No:
Account No:
Account No:
Account No:
Amount:
Amount:
Amount:
Amount:
POST MARK:
DATE PAID:
RECEIPT NO:
RECEIVED BY:
VERIFIED BY:
INPUT BY:
INPUT DATE:
Form: OS-3705 (Rev. 12/2001)
NOTE: This revision is effective 4th Quarter 2001.

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