Form 941p-Me - Pass-Through Entity Return Of Income Tax Withheld From Owners - 2004

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MAINE
040625000
REVENUE SERVICES
FORM 941P-ME LOOSE
PASS-THROUGH ENTITY RETURN OF INCOME TAX WITHHELD FROM OWNERS
Check here if the withholding amount is reduced
QUARTER #
Pass-through Withholding Account Number:
by a real estate withholding payment .............................
Period Covered:
1. Maine income tax withheld
-
.
for this quarter .......................... 1
,
,
-
-
-
-
-
.
Name and Address:
2. Less payments made ............. 2
,
,
3. Amount due with this return ..... 3
.
,
,
Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.
Date _____________ Signature ________________________________ Title _____________________________________ Telephone _________________________
Contact person e-mail _______________________________________ Paid preparer EIN:
-
Schedule 1 – Reconciliation of 900ME Voucher Payments or EFT Payments of Income Tax Withholding
For pass-through entities electing to remit withholding taxes on an estimated basis (see instructions).
Date of
Amount
Check
Date of
Amount
Check
Date of
Amount
Check
Withholding
Withheld
Amount
Withholding
Withheld
Amount
Withholding
Withheld
Amount
4. Total withholding this quarter (Enter here and on line 1 above)
5. Total prepayments remitted this quarter (Enter here and on line 2 above)
.
.
$
,
,
$
,
,
CANCELLATION NOTICE
6. Check this box and complete the following section if your
business is discontinued. ............................................................
FINAL
Make check payable to:
Treasurer, State of Maine
Mail to:
Maine Revenue Services
Reason for cancellation ___________________________________________________________________________
P.O. Box 9118
Augusta, ME 04332-9118
Note: Use the Name and Address Change Form (Form 941/C1C-ME) on page 5 to change your
business name or address.
Office use only

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