Form Mw506 Am - Maryland Employer Report Of Income Tax Withheld

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MARYLAND EMPLOYER REPORT OF INCOME TAX WITHHELD

AMNESTY

MW506 AM

COT/RAD-041

COMPTROLLER OF MARYLAND

P.O. BOX 1829

REV.8/01

REVENUE ADMINISTRATION DIVISION

ANNAPOLIS, MD 21404-1829

FOR THE PERIOD ENDING

DOLLARS

CENTS

M M D D Y Y Y Y

MARYLAND

INCOME TAX

FEIN

CENTRAL REGISTRATION

WITHHELD

NAME OF COMPANY

-INSTRUCTIONS-

DOLLARS

CENTS

This is an Adobe format fill in form if you are using a personal computer.

PAYMENT

If using pen, fill in all boxes. Payment amount should

AMOUNT

include tax and interest.

Sign below.

Send this form along with the Maryland Tax Amnesty Application (form AM01)

MAKE CHECKS PAYABLE TO: COMPTROLLER OF MARYLAND

I DECLARE UNDER THE PENALTIES OF PERJURY THAT THIS RETURN (INCLUDING ANY ACCOMPANYING SCHEDULES AND STATEMENTS) HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY

KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE REPORT.

AREA

PHONE

CODE

NO.

DATE:

SIGNED:

TITLE: