Form 941p-Me - Pass-Through Entity Return Of Maine Income Tax Withheld From Members - 2012 Page 3

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SCHEDULE 3P (FORM 941P- ME) 2012
99
Name:
Federal
*12941P3*
Identifi cation
No.:
01 01 2012 - 12 31 2012
Period Covered:
List of Exempt Members - File with Form 941P- ME
13. Partner/Shareholder Name (Last, First, MI.)
14. Social Security Number (EIN if
15. Check Here
16. Distributive
17. Participating in
other than an individual)
if EIN
Share %
Composite Return
a.
.
%
b.
.
%
.
c.
%
.
d.
%
e.
.
%
f.
.
%
.
g.
%
.
h.
%
.
i.
%
.
j.
%
k.
.
%
l.
.
%
.
m.
%
n.
.
%
.
o.
%
.
p.
%
.
q.
%
r.
.
%

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