Form 941p-Me - Pass-Through Entity Return Of Maine Income Tax Withheld From Members - 2012
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1
2
32012
MAINE REVENUE SERVICES
99
PASS-THROUGH ENTITY RETURN
FORM 941P-ME
OF MAINE INCOME TAX WITHHELD FROM MEMBERS
*12941P0*
04 30 2013
Due on or Before:
01 01 2012 - 12 31 2012
Period Covered:
Federal Identifi cation No:
A. Check this box and complete Schedule 3P if you are claiming the Compliant
Taxpayer or Composite Filing exemption from pass-through entity withholding
Amended return:
Check here if your address changed.
for any non-resident member. See Schedule 3P instructions ...........................
1.
Pass-through entity
withholding for this year
.
(from Schedule 2P, line 12) ..
Name
.
2.
Estimated Payments ............
3a. Amount due with this return
(line 1minus line 2, if line 1
Address
.
is greater than line 2)............
3b. Overpayment to be refunded
(line 2 minus line 1, if line 2
City
State
ZIPCode
.
is greater than line 1)............
Schedule 1P- Entity Apportionment
4a. Maine
4b. Everywhere
.00
Sales
.00
Sales
4c. Maine
.
Apportionment
Factor
5. Total Entity income or loss .............................................................................
.
00
$
Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.
Signature:
Date:
Print Name:
Telephone:
Contact Person Email:
For Paid Preparers Only
Paid Preparer’s Signature:
Date:
Telephone:
Firm’s Name (or yours, if self-employed):
Paid Preparer EIN:
Address:
See pages 3 and 4 for electronic fi ling and payment requirements and options
If enclosing a check, make check payable to:
If not enclosing a check,
Treasurer, State of Maine
MAIL RETURN TO:
and MAIL WITH RETURN TO:
MAINE REVENUE SERVICES
MAINE REVENUE SERVICES
P.O. BOX 1065
P.O. BOX 1064
AUGUSTA, ME 04332-1064
AUGUSTA, ME 04332-1065
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