Form Ro967a - 967 Idaho Annual Withholding Report - 2009 Page 2
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RO967B
RO967B
967 IDAHO ANNUAL WITHHOLDING REPORT
967 IDAHO ANNUAL WITHHOLDING REPORT
09//25/2009
09//25/2009
ACCOUNT NO.
ACCOUNT NO.
TAX YEAR
TAX YEAR
DUE ON OR BEFORE
DUE ON OR BEFORE
000256312
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Error!
2009
03/01/2010
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Error! Unknown
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x x
x x
Mailing address change
Mailing address change
Cancel Account
Cancel Account
REVENUE OPERATIONS QUALITY CONTROL
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Return mailing address: Idaho State Tax Commission
PO Box 76
PO BOX 36
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Boise, Idaho 83707-0076
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BOISE ID 83722-0410
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Wages and Withholding
1. Total Idaho taxable wages reported on W-2s ..............................................................
______________
x
2. Total Idaho tax withheld on W-2s and 1099s ..............................................................
...........
.......
______________
x
2009
3. Tax payments for calendar year 2008
1/01/09 to 1/15/09
3a. Enter income tax withheld 1/01/08 to 1/15/08 .............. ________________
________________
___________
1/16/09 to 1/15/10
3b. Add tax payments for period 1/16/08 to 1/15/09 ...........
.... ..
________________
_______________
____
x
x
1/01/10 to 1/15/10
3c. Less income tax withheld 1/01/09 to 1/15/09 ................
..........
........
________________
___________
___________
x
x
3d. Total tax paid during the year. (Add lines 3a and 3b, subtract line 3c.) ..............
and 3b, subtract line 3c.
and 3b, subtract line 3c
______________
x
4. Remaining tax due or (overpaid). Subtract line 3d from line 2. …..............................
ne 3d from line 2. …......
e 3d from line
______________
x
5. Penalty on balance owed. If line 4 is zero or a credit, enter 0. ...................................
o or a credit, enter 0. ....
a credit, enter 0
______________
x
6. Interest on balance owed. If line 4 is zero or a credit, enter 0. ...................................
s zero or a credit, enter 0
zero or a credit, enter 0
______________
x
7. Total due. Add lines 4, 5, and 6. ................................................................................
6. ...................................
......................
______________
x
Statements Submitted
8. Number of W-2s for the year (send W-2s with this form.
he year (send W-2s with
r
send W-2s with
..........................................
______________
)
x
9. Number of 1099s with Idaho withholding for the year (send 1099s with this form.
with Idaho withholding
with Idaho withho
______________
)
x
Check box if 1099s were submitted through combined federal/state filing ....
1099s were submitted
99s were submitted
x
10. Total number of statements. Add lines 8 and 9. ........................................................
ements. Add
ents. Add
_______________
x
11. Statement penalty. Add after due date.
after
f
Multiply line 10 by $2 per month for each full or part month overdue.
If submitted by due date, enter 0. .............................................................................
_______________
x
12. Add lines 7 and 11
12a. Total due .............................................................................................................
x
12b. Total refund .....................................................................................................
x
I certify under penalties of perjury that this return is true, correct and complete to the best of my knowledge
.
Authorized Signature
Date
x
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290555056 000256312 REVE 09 1209 B 67 4
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