Form 941me - Employer'S Return Of Maine Income Tax Withholding - 2010

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FORM 941ME
MAINE REVENUE SERVICES
2010
EMPLOYER’S RETURN
99
OF MAINE INCOME TAX WITHHOLDING
*1006220*
QUARTER #
Due on or Before:
Withholding Account Number:
-
-
-
,
MM
DD
YY
A.
Number of payees subject to Maine income tax withholding ..........A.
Period Covered:
-
-
to
-
-
B.
Check here if MRS granted an exception to report non-wage
MM
DD
YY
MM
DD
YY
withholding detail annually on magnetic media. See instructions ..................................... B.
Name and Address:
1.
Maine income tax withheld for this
.
$
,
,
Quarter (from Schedule 2, line 11) .......1.
2.
Less semiweekly payments (from
Name
$
.
Schedule 1, line 6) ...............................2.
,
,
3a. Amount due with this return (if line 1
Address
$
.
,
,
is greater than line 2) .........................3a.
3b. Overpayment to be refunded (if line 2
City
State
ZIP Code
$
.
,
,
is greater than line 1) .........................3b.
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:__________________________________
-
Firm’s Name (or yours, if self-employed):_____________________________________
Paid Preparer EIN:
Maine Payroll Processor License Number:
Address:_______________________________________________________________
Note: Use the Business Notifi cation Change Form (Form 941BN-ME) on page 3 to change your business name or address.
See Page 6 for Electronic Filing and Payment Requirements and Options
Make check payable to:
Treasurer, State of Maine
Mail return and check to:
Maine Revenue Services
P.O. Box 1061
Augusta, ME 04332-1061
Offi ce use only
PWD

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