Form M-941d Wr - Quarterly Return Of Income Taxes Withheld For Employer Paying Weekly

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MASSACHUSETTS DEPARTMENT OF REVENUE
M-941D
QUARTERLY RETURN OF INCOME TAXES WITHHELD FOR EMPLOYER PAYING WEEKLY
WR
YOU MUST FILE THIS FORM EVEN THOUGH NO TAX MAY BE DUE.
FEDERAL IDENTIFICATION NUMBER
BE SURE THIS RETURN COVERS
FOR QTR. ENDING
1. AMOUNT WITHHELD
THE CORRECT PERIOD
2. ADJUSTMENT FOR PRIOR
IF INCORRECT, SEE INSTRUCTIONS. DO NOT ALTER.
QTR. AMOUNT WITHHELD*
3. AMOUNT DUE AFTER
IF ANY
ADJUSTMENT
INFOR-
4
A
. PREVIOUS PAYMENTS
MATION IS
MADE**
INCORRECT,
4
B
. CREDIT FROM
PREVIOUS QUARTER
SEE
INSTRUC-
4
C
. TOTAL (ADD LINE 4A
AND LINE 4B)
TIONS.
Check here if this is a final return.
Check here if EFT payment.
5. TOTAL TAX DUE (SUBTRACT
LINE 4C FROM LINE 3)
6. PENALTIES AND INTEREST
7. TOTAL AMOUNT DUE
(ADD LINE 5 AND LINE 6)
8. AMOUNT OVERPAID TO BE
Make check payable to the Commonwealth of Mass. Return this completed form with payment. Mail to: Mass-
CREDITED TO NEXT PERIOD*
achusetts Department of Revenue, PO Box 7034, Boston, MA 02204-7034.
I declare under the penalties of perjury that this return (including any accompanying schedules and statements)
9. AMOUNT OVERPAID TO BE
has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.
REFUNDED*
*See instructions. Explain any adjustment on reverse or it will be disallowed.
Adjustment must be from immediate prior period.
Signature
Title
Date
**List all payments made for this quarter on reverse.
NEW OWNERS — DO NOT USE PREVIOUS OWNER’S
NOTE: THE ENTIRE OVERPAYMENT AMOUNT
LIST DATES AND AMOUNTS OF PAYMENTS
MADE FOR THIS QUARTER (M-941W):
FORM TO FILE YOUR RETURN. ANY CHANGE IN OWNER-
MUST BE EITHER CREDITED OR REFUNDED.
SHIP OR ORGANIZATION REQUIRES A NEW REGISTRA-
DO NOT SPLIT THE OVERPAYMENT AMOUNT
TION. YOU MUST FILE A NEW FORM TA-1.
BETWEEN LINE 8 AND LINE 9.
DATE
AMOUNT
STATE REASON FOR ADJUSTMENT REQUEST:
ADJUSTMENT INFORMATION
AS REPORTED
CORRECTED
AMOUNT
WITHHELD
ADJUSTMENT
PRIOR PERIOD
AMOUNT
PAID
REPORTED UNDER
FED. IDENT. NO.
REPORTING
PERIOD IN ERROR
TOTAL

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