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FORM 941/C1-ME

MAINE REVENUE SERVICES

MAINE DEPARTMENT OF LABOR

2013

COMBINED FILING FOR INCOME TAX WITHHOLDING

AND UNEMPLOYMENT CONTRIBUTIONS

*1308500*

Name:

QUARTER # 1

Withholding

Account No.:

2013

01 01 2013 - 03 31 2013

Period Covered:

YYYY

UC Employer

File On or Before:

04 30 2013

Account No:

YYYY

Part One - Income Tax Withholding

Maine income tax withheld this quarter (from Schedule 2/C1, line 18b)

(Semiweekly ﬁ lers complete Schedule 1/C1 on reverse side) ............................................................1.

Less any semiweekly payments (From Schedule 1/C1, line 12 on reverse side)

(See instructions for Schedule 1/C1 on page 7) .................................................................................2.

Income tax withholding due (line 1 minus line 2) ................................................................................3.

Part Two - Unemployment Contributions Report

For each month, enter the total of all full-time and part-time workers who worked during,

1st Month

2nd Month

3rd Month

or received pay reportable for unemployment contributions purposes for the payroll period

which includes, the 12th of each month. If you had no employment in the payroll period,

enter zero (0) ..................................................................................................................................... 4.

Number of female employees included on line 4. If none, enter zero (0) .......................................... 5.

Total unemployment contributions gross wages paid this quarter

(from Schedule 2/C1, line 18a) ......................................................................................................... 6.

EXCESS WAGES (SEE INSTRUCTIONS) ........................................................................................ 7.

NOTE: THE TAXABLE WAGE BASE IS $12,000 FOR EACH EMPLOYEE.

Taxable wages paid in this quarter (line 6 minus line 7) ..................................................................... 8.

9a. UC contributions rate

UC contributions due (line 8 times line 9a) . .. 9b.

9c. CSSF rate

.0006

CSSF assessment (line 8 times line 9c)............. 9d.

Note: The CSSF assessment does not apply to direct reimbursable employers. See instructions.

10. Total contributions and CSSF assessment due (line 9b plus line 9d)...............................................10.

Part Three - Calculate the Total Amount Due

11. Amount due with this return (line 3 plus line 10) ...............................................................................11.

See page 8 for electronic ﬁ ling and payment requirements and options

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:

If enclosing a check, make check payable to:

If not enclosing a check,

Firm’s Name (or yours, if self-employed):

Treasurer, State of Maine

MAIL RETURN TO:

and MAIL WITH RETURN TO:

MAINE REVENUE SERVICES

Address:

P.O. BOX 1065

P.O. BOX 1064

AUGUSTA, ME 04332-1065

AUGUSTA, ME 04332-1064

Ofﬁ ce Use Only

Maine Payroll Processor

License Number:

Paid Preparer EIN:

Form 941/c1-Me - Combined Filing For Income Tax Withholding And Unemployment Contributions - 2013

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