Form 941 - Employers Quarterly Federal Tax Return, Schedule B (Form 941): Report Of Tax Liability For Semiweekly Schedule Depositors - 2010 Page 3
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Schedule B(Form941):
Report of Tax Liability for Semiweekly Schedule Depositors
OMB No. 1545-0029
(Rev. February 2009)
Department of the Treasury - Internal Revenue Service
Report for this Quarter ...
(EIN)
1
2
3
4
5
6
7
8
9
(Check one.)
Employer identification number
Sample Company
X
Name (not your trade name)
1:
January, February, March
2
0
1
0
2:
April, May, June
Calendar year
(Also check quarter)
July, August, September
3:
4:
October, November, December
Use this schedule to show your TAX LIABILITY for the quarter; DO NOT use it to show your deposits. When you file this form with Form 941
(or Form 941-SS) DO NOT change your tax liability by adjustments reported on any Forms 941-X. You must fill out this form and attach it to
Form 941 (or Form 941-SS) if you are a semiweekly schedule depositor or became one because your accumulated tax liability on any day
was $100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in
Pub. 15 (Circular E), Employer's Tax Guide, for details.
Month 1
Tax liability for Month 1
1
9
17
25
3194
58
2
10
18
26
3
11
19
27
4
12
20
28
699
27
5
13
21
29
732
79
6
14
22
30
1024
12
7
15
23
31
738
40
8
16
24
Month 2
Tax liability for Month 2
1
9
17
25
986
77
2
10
18
26
3695
02
1238
51
3
11
19
27
743
36
4
12
20
28
726
38
5
13
21
29
6
14
22
30
7
15
23
31
8
16
24
Month 3
Tax liability for Month 3
1
9
17
25
1290
73
2
10
18
26
3532
13
831
40
3
11
19
27
769
09
4
12
20
28
640
91
5
13
21
29
6
14
22
30
7
15
23
31
8
16
24
Total liability for the quarter
Fill in you total liablity for the quarter (Month 1 + Month 2 + Month 3) = Total tax liability for the quarter
Total must equal line 10 on Form 941 (or line 8 on Form 941-SS).
10421
73
For Paperwork Reduction Act Notice, see separate instructions.
Schedule B (Form 941) Rev. 2-2009
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