Form 941 - Employers Quarterly Federal Tax Return, Schedule B (Form 941): Report Of Tax Liability For Semiweekly Schedule Depositors - 2010
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941 for 2010:
Employer's QUARTERLY Federal Tax Return
Form
OMB No. 1545-0029
Department of the Treasury -- Internal Revenue Service
(Rev. February 2010)
(EIN)
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Report for this Quarter of 2010
Employer identification number
(Check one.)
Sample Company
Name (not your trade name)
X
January, February, March
1:
123 Lawn And Garden Inc
Trade Name (if any)
2:
April, May, June
9000 Easy Street
3:
July, August, September
Address
Number
Street
Suite or room number
4:
October, November, December
Myhometown
KY
40000
City
State
ZIP code
Read the separate instructions before you complete Form 941. 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
12
including:
Mar. 12
(Quarter 1),
June 12
(Quarter 2),
Sept. 12
(Quarter 3),
Dec. 12
(Quarter 4)
1
44583
61
2
Wages, tips, and other compensation
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2
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3600
31
3
Income tax withheld from wages, tips, and other compensation
3
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4
If no wages, tips, and other compensation are subject to social security or Medicare tax
Check and go to line 6.
5
Taxable social security and Medicare wages and tips:
Column 1
Column 2
44583
61
5528
37
x .124 =
5a Taxable social security wages
0
00
0
00
x .124 =
5b Taxable social security tips
44583
61
1292
92
x .029 =
5c Taxable Medicare wages & tips
6821
29
5d Total social security and Medicare taxes (Column 2, lines 5a + 5b + 5c = line 5d)
5d
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.
10421
60
6
Total taxes before adjustments (lines 3 + 5d = line 6)
6
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7
CURRENT QUARTER'S ADJUSTMENTS, for example, a fractions of cents adjustment.
See the instructions.
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7a Current quarter's fractions of cents
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7b Current quarter's sick pay
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7c Current quarter's adjustments for tips and group-term life insurance
0
13
7d TOTAL ADJUSTMENTS. Combine all amounts on lines 7a through 7c
7d
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10421
73
8
Total taxes after adjustments. Combine lines 6 and 7d
8
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0
00
9
Advance earned income credit (EIC) payments made to employees
9
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10421
73
10
Total taxes after adjustment for advance EIC (line 8 - line 9 = line 10)
10
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11
Total deposits for this quarter, including overpayment applied
from a prior quarter and overpayment applied from Form 941-X or
10421
73
Form 944-X
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COBRA premium assistance payments (see instructions)
12a
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12b
Number of individuals provided COBRA premium
assistance reported on line 12a .
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10421
73
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Add lines 11 and 12a
13
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Balance due. If line 10 is more than line 13, write the difference here. For information on
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how to pay, see the instructions.
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Apply to next return.
Overpayment. If line 13 is more than line 10, write the difference here
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Check one
Send a refund.
Next
You MUST complete both pages of Form 941 and SIGN it.
941
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Form
(Rev. 2-2010)
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