Form Fr-900np Draft - Annual Return For Withholding Reported On Forms 1099 And/or W-2g
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1DRAFT AS OF 06/08/16 - DO NOT FILE*
Government of the
*17900NP10000*
2017 FR-900NP
Annual Return
District of Columbia
for Withholding Reported on
Important: Print in CAPITAL
Forms 1099 and/or W-2G
letters using black ink.
Vendor ID#0000
Federal Employer Identification Number
Account Number
OFFICIAL USE ONLY
Fill in
if Amended Return
Tax period ending (MMYY)
Name (not your trade name)
If you do not have to file returns
in the future, fill here
and enter below date final
Business mailing address #1
payments made.
(MMDDYYYY)
Business mailing address #2
City
State
Zip Code + 4
$
.
1
DC Income Tax Withheld this year on non-wage payments (1099/W-2G).....
1
.
.
.
$
.
2
Total payments......................................................................................
2
.
$
3
Balance Due.........................................................................................
3
.
.
$
.
4
Overpayment........................................................................................
4
.
Fill in only one:
Credit carry forward
Send a refund
5
Monthly Summary of amounts withheld.
Tax withheld for each month
Tax withheld for each month
$
$
.
.
.
G
July...........
A
January...
.
$
$
.
.
H
August.......
B
February..
.
.
$
$
.
I
September.
.
C
March.....
.
.
$
$
.
J
October.....
.
D
April.......
.
.
$
$
.
.
K
November..
E
May........
.
.
$
$
.
.
L
December..
F
June.......
.
.
$
M
Tax withheld for year (add Lines A through L)................
.
.
Sign Here
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid preparer is based on
information available to the preparer.
Daytime telephone number
Sign your name
Print your name
Date
Preparer’s signature
Preparer’s name
Date
Preparer's Tax Identification Number (PTIN)
Third party designee To authorize another person to discuss this return with OTR, fill in here
and enter the name and phone number of that person. See instructions.
Phone number
Designee's name
2017
FR-900R P1
Revised 05/16
Employer/Payor Withholding Tax page 1
This form is subject to change pending any forthcoming District Legislative or Administrative decisions and should not be used for filing purposes.
*
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