1 Number of employees who received wages, tips, or other compensation for the pay period including: Mar. 12 (Quarter 1) 2 Wages, tips, and other compensation 3 Federal income tax withheld from wages, tips, and other compensation 4 If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 5a Taxable social security wages......... 18,7500,124= Sa (1) Qualified sick leave wages . . . . . ...... 0) 0.062= 5 a (ii) Qualified family leave wages ........ 00.062= 5b Taxable social security tips ........... 5 c Taxable Medicare wages 8 tips ......... o 0.124= 5d Taxable wages 8 tips subject to Additional Medicare Tax withholding Check and go to line 6 . Column 2 2,325 0 0 543.75 0 0.009= 5e Total social security and Medicare taxes. Add Column 2 from lines 5a,5a(0),5a(ii),5b,5c,and5d 2,868.75 5f Section 3121 (q) Notice and Demand-Tax due on unreported tips (see instructions) 51 o 6 Total taxes before adjustments. Add lines 3, 5e, and 5f. 6 4,743.75 7 Current quarter's adjustment for fractions of cents 7 8 Current quarter's adjustment for sick pay 8 9 Current quarter's adjustments for tips and group-term life insurance 9 10 Total taxes after adjustments. Combine lines 6 through 9 . 10 1 Number of employees who received wages, tips, or other compensation for the pay period including: Mar. 12 (Quarter 1) 2 Wages, tips, and other compensation 3 Federal income tax withheld from wages, tips, and other compensation 4 If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 5a Taxable social security wages......... 18,7500,124= Sa (1) Qualified sick leave wages . . . . . ...... 0) 0.062= 5 a (ii) Qualified family leave wages ........ 00.062= 5b Taxable social security tips ........... 5 c Taxable Medicare wages 8 tips ......... o 0.124= 5d Taxable wages 8 tips subject to Additional Medicare Tax withholding Check and go to line 6 . Column 2 2,325 0 0 543.75 0 0.009= 5e Total social security and Medicare taxes. Add Column 2 from lines 5a,5a(0),5a(ii),5b,5c,and5d 2,868.75 5f Section 3121 (q) Notice and Demand-Tax due on unreported tips (see instructions) 51 o 6 Total taxes before adjustments. Add lines 3, 5e, and 5f. 6 4,743.75 7 Current quarter's adjustment for fractions of cents 7 8 Current quarter's adjustment for sick pay 8 9 Current quarter's adjustments for tips and group-term life insurance 9 10 Total taxes after adjustments. Combine lines 6 through 9 . 10