Form M-3 - Reconciliation Of Massachusetts Income Taxes Withheld For Employers Filing Quarterly

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M-3
MASSACHUSETTS DEPARTMENT OF REVENUE
RECONCILIATION OF MASSACHUSETTS INCOME TAXES WITHHELD FOR EMPLOYERS FILING QUARTERLY
W1,R
YOU MUST FILE THIS FORM EVEN THOUGH NO TAX MAY BE DUE.
FEDERAL IDENTIFICATION NUMBER
BE SURE THIS FORM COVERS
FOR YEAR
1. TOTAL NUMBER EMPLOYED
THE CORRECT PERIOD
DURING THE YEAR
IF INCORRECT, SEE INSTRUCTIONS. DO NOT ALTER.
2. TOTAL NUMBER OF FORMS W-2
BUSINESS NAME
ENCLOSED
IF ANY
INFOR-
3. TOTAL MASSACHUSETTS TAX
BUSINESS ADDRESS
MATION IS
WITHHELD AS SHOWN ON
FORMS W-2
INCORRECT,
SEE
CITY/ TOWN
STATE
ZIP
4. TOTAL AMOUNT WITHHELD
INSTRUC-
PER LINE 3 OF QUARTERLY
RETURNS (from reverse)
TIONS.
Check here if this is a final return.
5. TOTAL AMOUNT REMITTED
(from reverse)
Explain on the back of this form any difference between the amounts shown
in lines 3 and 4 and file an amended return(s) for the applicable period(s).
Due on February 28 with Forms W-2, Copy 1. Note: Do not mail Forms M-3 or W-2 with Forms M-941, M-941D
or M-941W. Mail to: Massachusetts Department of Revenue, PO Box 7015, Boston, MA 02204.
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 return.
Signature
Title
Date
Amount withheld
Amount
(from quarterly returns, line 3)
remitted
State reason for difference:
1st quarter
2nd quarter
3rd quarter
4th quarter
Total
Enter total amounts on the front of this form.

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