Form 941-Ss - Employer'S Quarterly Federal Tax Return - American Samoa, Guam, The Commonwealth Of The Northern Mariana Islands, And The U.s. Virgin Islands - 2006

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941-SS for 2006:
Employer’s QUARTERLY Federal Tax Return
Form
American Samoa, Guam, the Commonwealth of the Northern
(Rev. October 2006)
OMB No. 1545-0029
Mariana Islands, and the U.S. Virgin Islands
Department of the Treasury — Internal Revenue Service
(EIN)
—
Report for this Quarter ...
Employer identification number
(Check one.)
Name (not your trade name)
1: January, February, March
Trade name (if any)
2: April, May, June
Address
3: July, August, September
Number
Street
Suite or room number
4: October, November, December
City
State
ZIP code
Read the separate instructions before you fill out this form. Please type or print within the boxes.
Part 1: Answer these questions for this quarter.
1
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), Dec. 12 (Quarter 4)
1
2
3
4 If no wages, tips, and other compensation are subject to social security or Medicare tax
Check and go to line 7.
5
Taxable social security and Medicare wages and tips:
Column 1
Column 2
.
.
5a
Taxable social security wages
.124 =
.
.
5b
Taxable social security tips
.124 =
.
.
5c
Taxable Medicare wages & tips
.029 =
.
5d
Total social security and Medicare taxes
(Column 2, lines 5a + 5b + 5c = line 5d)
5d
6
7
TAX ADJUSTMENTS (Read the instructions for line 7 before completing lines 7a through 7h.):
.
7a
Current quarter’s fractions of cents
.
7b
Current quarter’s sick pay
.
7c
Current quarter’s adjustments for tips and group-term life insurance
7d
.
7e
Prior quarters’ social security and Medicare taxes (attach Form 941c)
7f
.
7g
Special additions to social security and Medicare (attach Form 941c)
.
7h
TOTAL ADJUSTMENTS (Combine all amounts: lines 7a through 7g.)
7h
.
8
Total taxes after adjustments (Combine lines 5d and 7h.)
8
9
10
.
11
Total deposits for this quarter, including overpayment applied from a prior quarter
11
.
12
12
Balance due
(If line 8 is more than line 11, write the difference here
Make checks payable to United States Treasury.
.
Check one
Apply to next return.
13
Overpayment (If line 11 is more than line 8, write the difference here.)
Send a refund.
You MUST fill out both pages of this form and SIGN it.
Next
941-SS
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 17016Y
Form
(Rev. 10-2006)

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