Employer'S Quarterly Federal Tax Return

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941 for 2005:
9501
Employer's Quarterly Federal Tax Return
Form:
Department of the Treasury --- Internal Revenue Service
OMB No. 1545-0029
(Rev. January 2005)
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Report for this quarter ...
Employer Identification number
(Check One.)
Dennis R Keen
Name (not your trade name)
X
1: January, February, March
Calvary World Outreach Church
Trade name (if any)
X
2: April, May, June
Cranberry Road
1413
Address
X
3: July, August, September
Street
Suite or room number
Number
X
4: October, November, December
Aberdeen
MD
21130
City
State
ZIP code
Read the separate instructions before you fill out this form. Please type or print within the boxes.
Part 1: Answer these questions for this quarter
1. Number of employees who received wages, tips, or other compensation for the pay period
3
Including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept.12 (Quarter 3), Dec. 12 (Quarter 4)
1
2,320.00
2. Wages, tips, and other compensation
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.2
260.27
3. Total Income tax withheld from wages, tips, and other compensation .
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.3
X
Check and go to line 6.
4. If no wages, tips, and other compensation are subject to social security or Medicare tax . . . . .
5. Taxable social secuity and Medicare wages and tips:
Column 1
Column 2
400.00
49.60
X .124 =
5a Taxable social security wages
0.00
0.00
5b Taxable social security tips
X .124 =
5c Taxable Medicare wages & tips
400.00
11.60
X .029 =
61.20
5d Total social security and medicare Taxes (Column 2, lines 5a + 5b + 5c = line 5d)
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.5d
321.47
6. Total taxes before adjustments (lines 3 + 5d = line 6).
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. 6
7. Tax adjustments (If your answer is a negative number, write it in brackets.):
0.00
7a Current quarter's fractions of cents
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0.00
7b Current quarter's sick pay
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0.00
7c Current quarter's adjustments for tips amd group-term life insurance
0.00
7d Current year's income tax withholding (Attach Form 941c) . . . . .
0.00
7e Prior quarters' social security and Medicare taxes (Attach Form 941c)
0.00
7f Special additions to federal income tax (reserved use) .
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0.00
7g Special additions to social security and Medicare (reserved use)
0.00
7h Total adjustments (Combine all amounts: lines 7a through 7g.)
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7h
321.47
8. Total taxes after adjustments (Combines lines 6 and 7h.)
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.8
0.00
9. Advance earned income credit (EIC) payments made to employees
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. 9
321.47
10. Total taxes after adjustment for advance EIC (lines 8 - 9 = line 10).
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. .
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.10
321.47
11. Total deposit for this quarter, including overpayment applied from a prior quarter . . . . . . .11
0.00
12. Balance due (lines 10 - 11 = line 12) Make checks payable to the United States Treasury
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. 12
Check One X Apply to next return.
13. Overpayment (if line 11 is more than line 10, write the difference here.)
X Send a refund.
Next >
941
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No 17001Z
Form
(Rev. 1-2005)

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