Form 1049w89701 - Claim For Revision Page 2

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FORM 1049W_89701
PAGE 2
QUARTERLY RECONCILIATION OF DELAWARE TAX WITHHELD
CORRECTED
CORRECTED
CORRECTED
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
TAX
TAX
TAX
JANUARY
REMITTED
FEBRUARY
REMITTED
MARCH
REMITTED
WITHHELD
WITHHELD
WITHHELD
1st-3rd
1st-3rd
1st-3rd
4th-7th
4th-7th
4th-7th
8th-11th
8th-11th
8th-11th
12th-15th
12th-15th
12th-15th
16th-19th
16th-19th
16th-19th
20th-22nd
20th-22nd
20th-22nd
23rd-25th
23rd-25th
23rd-25th
26th-LAST
26th-LAST
26th-LAST
TOTAL
TOTAL
TOTAL
CORRECTED
CORRECTED
CORRECTED
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
TAX
TAX
TAX
REMITTED
REMITTED
REMITTED
JUNE
APRIL
MAY
WITHHELD
WITHHELD
WITHHELD
1st-3rd
1st-3rd
1st-3rd
4th-7th
4th-7th
4th-7th
8th-11th
8th-11th
8th-11th
12th-15th
12th-15th
12th-15th
16th-19th
16th-19th
16th-19th
20th-22nd
20th-22nd
20th-22nd
23rd-25th
23rd-25th
23rd-25th
26th-LAST
26th-LAST
26th-LAST
TOTAL
TOTAL
TOTAL
CORRECTED
CORRECTED
CORRECTED
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
TAX
TAX
TAX
REMITTED
REMITTED
JULY
AUGUST
REMITTED
SEPTEMBER
WITHHELD
WITHHELD
WITHHELD
1st-3rd
1st-3rd
1st-3rd
4th-7th
4th-7th
4th-7th
8th-11th
8th-11th
8th-11th
12th-15th
12th-15th
12th-15th
16th-19th
16th-19th
16th-19th
20th-22nd
20th-22nd
20th-22nd
23rd-25th
23rd-25th
23rd-25th
26th-LAST
26th-LAST
26th-LAST
TOTAL
TOTAL
TOTAL
CORRECTED
CORRECTED
CORRECTED
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
TAX
TAX
TAX
REMITTED
REMITTED
REMITTED
OCTOBER
NOVEMBER
DECEMBER
WITHHELD
WITHHELD
WITHHELD
1st-3rd
1st-3rd
1st-3rd
4th-7th
4th-7th
4th-7th
8th-11th
8th-11th
8th-11th
12th-15th
12th-15th
12th-15th
16th-19th
16th-19th
16th-19th
20th-22nd
20th-22nd
20th-22nd
23rd-25th
23rd-25th
23rd-25th
26th-LAST
26th-LAST
26th-LAST
TOTAL
TOTAL
TOTAL
The Claimant believes that this claim should be allowed for the following reasons: (Attach an additional sheet if needed.)
*DF42314029999*
Revised 12/30/13

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