Form Fr-900m - Employer/payor Withholding Tax - Monthly Return - 2013
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1This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
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2013
FR-900M Employer/Payor
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Government of the
*139000310002*
District of Columbia
Withholding Tax – Monthly Return
l
Clear
Taxpayer Identification Number
Account Number
Fill in
if FEIN
Fill in
if SSN
Tax Period Ending (MMYY)
OFFICIAL USE ONLY
Vendor ID#0002
Fill in
if final return
Business name
1213
Fill in
if non-wage
Due Date:
Business mailing address 1
01202014
.
1. DC income tax withheld
$
.
this month per W2’s/1099’s
Business mailing address 2
2. Adjustment to a previous
.
$
month of this year. Fill
.
City
State
Zip Code + 4
in circle if a minus.
.
$
.
3. Tax Due
Telephone number of person to contact
Under penalties of law, I declare that, to the best of my knowledge, this return is correct.
Preparer’s PTIN
Declaration of paid preparer is based on the information available to the preparer.
Taxpayer’s signature
Title
Date
Paid Preparer’s Signature
Date
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2013 FR-900M
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