During the fourth quarter of 2016, there were seven biweekly paydays on Friday (October 7, 21; November 4, 18; December 2, 16, 30) for Clarke's Roofing. Using the forms supplied on pages 4-58 to 4-61, complete the following for the fourth quarter:

a. Complete the Federal Deposit Information Worksheets, reflecting electronic deposits (monthly depositor). The employer's phone number is (501) 555-1212. Federal deposit liability each pay, $1,304.56.

b. Employer's Quarterly Federal Tax Return, Form 941. The form is signed by you as president on January 31, 2017.

c. Employer's Report of State Income Tax Withheld for the quarter, due on or before January 31, 2017.

To be deposited on or before ______________

To be deposited on or before ______________

To be deposited on or before ______________

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Quarterly Payroll Data Total Earnings 5 Employees $37,450.00 Employer's OASDI Employer's HI Federal deposit liability each pay OASDI $2,321.90 %2,321.90 HI FIT SIT $543.06 3,402.00 $2,621.50 543.06 1,304.56 EMPLOYER'S REPORT OF STATE INCOME TAX WITHHELD 00-0-8787 DEC 20- IF YOU ARE A SEA SONAL EMPLOYER CLARKE'S ROOFING 20 SUMMIT SQUARE CITY, STATE 00000-0000 FINAL REPORT FOR HIS SEASON, CHICK AND SHOW THE MONTH FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Nub 00-0004701 Month Tax Year Ends12_ Type of Tax (Form)_ Address City, State, Zip ame Amount of Deposit Tax Period Phone Number 20 SUMMIT SQUARE CITY, STATE 00000-0000 FEDERAL DEPOSIT INFORMATION WORKSHEET Employer CLARKE'S ROOFING Identification Number 00-0004701 Month Tax Year Ends Type of Tax (Form Address C CrTY.STATE 00000-0000 Name Amount of Deposit Tax Period Phone Number 12 ity, State, Zip FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number Month Tax Year Ends Type of Tax (Form 00-0004701 CLARKE'S ROOFING Name Amount of Deposit Tax Period Phone Number 12 Address City, State, Zip CITY, STATE 00000-0000 Fam 941 for 20--: Employer's QUARTERLY Federal Tax Return January Dopartmant of the Treasry - Intamual Rowarue Sarvice OMB No. 1545-0020 7O 1Report fothis Quarter of 20- Employer identafication numbor (EN Nama ot your tradaa CLARKE'S ROOFING Trade name pany) Check ona 1:January, February, March 2 Apri, May, June ГЈа July, August, September Address 20 SUMMIT SQUARE 4 October, November, December Instructons and prior year forms are avallable at www.irs.gowrom941 CITY ST 00000-0000 Read the separate instructions before you complete Fomm 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 including: Mar. 12 (Quarter ), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12(Quarter 4 1 2 3 4 Wages, tips, and other compensation Federal income tax withheld from wages, tips, and other compensation If no wages, tips, and other compensation are subject to social security or Medicare Check and go to line 6. Column 1 Column 2 5a 5b 5c 5d Taxable social security wages x.124 x.124 x.029- Taxable social security tips . . . Taxable Medicare wages & tips. . Taxable wages & tips subject to Additional Medicare Tax withholding x.009- 5e Add Column 2 from lines 5a, 5b, 5c, and 5d 5f Section 3121(q) Notice and Demand-Tax due on unreported tips (see instructions) 6 Total taxes before adjustments. Add lines 3, 5e, and 5f 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. Combine lines 6 through 9 11 Total deposits for this quarter, including overpayment applied from a prior quarter and 5f 10 overpayments applied from Form 941-X, 941-X (PR), 944-X, 944-Х (PR), or 944-X (SP) filed in the current quarter 12 Balance due. If line 10 is more than line 11, enter the difference and see instructions 12 13 Overpayment. If line 11 is more than line 10, enter the diffierenoe Check one:Applyto naxttLSand a ratund You MUST complete both pages of Form 941 and SIGN it. Next For Prtvacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher Fomm 941 (Rav. 1-2015) dontfication number (EIN) CLARKE'S ROOFING 00-0004701 Part 2 Tell us about your deposit schedule and tax liability for this quarter It you are unsure about whether you are a monthly schedule deposltor or a semlweekly schedule depositor, see Pub. 15 (Circular E), section 11. 14 Check one:Line 10 on this rotum is ss than $2,500 or lina 10 on the raburm for tho prior quartar was loss than $2,500, and you did not incur $100,000 next-day daposit obligation during the curront quartor. If ine 10 for the prior quartar was loss than $2,500 but line 10 on this raturn Fyou aro a monthly schodula dapositor, complate the daposit $100,000 or mora, you must providea racond of your fodoral tx schadula balow; if you aro a samiweakdy schodule dapositor, attach Schodulo B(Form 941). Go to Part 3 You were a monthly schedule depositor for the entre quarter. Enter your tax lablity for each month and total llablity for the quarter, then go to Part 3. Tax llablty: Month 1 Month 2 Month 3 Total Ilability for quarter Total must equal line 10. □ You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B Form 941), Report of Tax Liablity for Semiweekly Schedule Depositors, and attach it to Form 941 Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 15 If your business has closed or you stopped paying wages Check here, and enter the final date you pald wages 16 If you are a seasonal employer and you do not have to tle a return for every quarter of the year Check here. Part 4: May we speak with your third-party designee? Do you want to allow an employee, a pald tax preparer, or or detalls. person to discuss Yes. Designee's name and phone number Select a 5-digit Personal Identinication Number (PIN) to use when talking to the IRS. □□□□□ No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. Undar panatios of parjury, I daclaro that I havo axaninad this roburn, including accompanying schoduks and statamonts, and to the bost of my knowladga and baliof, it is trua, corract, and complate. Daclaration of praparar (othar than taxpayor is basad on all information of which proparor has any knowladga Print your name here Print your itile here Sign your name here Date Best daytime phone reparer Check It you are self-employed Preparer's name Preparer's signature Arm's name (or PTIN Date EIN AddressS Phone city State ZIP code Fom 941 Fav. 1-2015