16. Form 941. (Obj. 6) During the third quarter of 2020, the Fillmore Restaurant (EIN 931 0530660) located at 244 North Second Street, Fillmore, New York 14735-0022, withheld income and social security taxes from its five employees. It withheld income taxes of $3,117 from employees' wages and tips of $15,570. In addition, Fillmore withheld $912.95 of social security taxes on $17,725 of social security wages, and $52.39 of social security taxes on $845 of social security tips. It also withheld $225.77 of Medicare taxes on $15,570 of Medicare wages. During the quarter, Fillmore electronically deposited income and employment taxes as follows: August 15, $1,833.52; September 15, $1,790.26; October 15, $1,875.43. Data for quarterly wages and reported tips of employees is as follows: Name Total Wages Social Security Wages Taxable Tips Reported Barker, J. R. $ 7,025 $ 7,025 $315 Duwe, H. K. 3,000 3,000 Miller, M. M. 2,000 2,000 120 Pressman, R. M. 1,200 1,200 125 Smathers, H. H. 1,500 1,500 105 $14,725 $14,725 $845 180 Prepare the third quarter Form 941, Employer's QUARTERLY Federal Tax Return, for the Fillmore Restaurant, using the blank form provided on the pages that follow. Fillmore filed Form 941 and M. L. Wright, President, signed it on October 25, 2020. From 941 for 2020: Employer's QUARTERLY Federal Tax Return 950120 ONONO 1545-001 Rev. July 2020 Department of the Treasury - Internal Revenue Service Employer identification number EN Name that your trade nama Trade ramefany Report for this Quarter of 2020 Check 1. January February March 2. Ap. May, June 3: July August September 4: Ocrober November December Go to www.is.gov.lForm41 for instructions and the latest information CDRAFT AS August 28, 2020 Address Read the separate instructions before you complete Form 941. Type or print within the boxes Part 1: Answer these questions for this quarter. 1 Mumber of employees who received wages, tips, or other compensation for the pay period including: Sept. 12 (Quarter 3) or Dec 12 (Quarter 2 Wages, tips, and other compensaron 3 Federal income tax withheld from wages, tips, and other compensation Check and go to ling & 4 I no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 2 Ba Taxable social security wages x 0.124 ta Qualified sick leave wages x 0.062 5 Qualified family leave wages x 0.02 5b Taxable social security tips 0.134 50 Taxable Medicare wages & tips. x 0.029 5d Taxable wages & tips subject to Additional Medicare Tax withholding x 0.000 = I 5e Total social security and Medicare taxes. Add Column 2 from Ines 50, 5). Sall. 56, 5c, and 5d of Section 3121) Notice and Demand-Tax due on unreported tips (see instructional 5f 6 Total taxes before adjustments. Add lines 3, Se, and 5 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 & though 101 1ta Qualified small business payroll tax credit for increasing research activities Attach Form 2074 110 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 116 110 Nonrefundable portion of employee retention credit from Worksheet 1 110 You MUST complete all three pages of Form 941 and SIGN IL For Primacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat No. 170012 Fom 2000 Neend your trade name Part 1 Answer these questions for this quarter. continued 950220 11d Total nonrefundable credits. Add lines 114, 115, and 110 110 12 Total taxes after adjustments and nonrefundable credite Suburactie 11d homine 10 13a Total deposits for this quarter, eluding mment applied from end overpayment oppled from Form 91-941-X PR. 044-X, or 9-X (SP) in the wront quarter 13b Deferred amount of social security tax 13c Refundable portion of credit for mily leave wages from Worksheet 13d Rehindable portion of me 130 Total deposits, deferrals, and refundable credits. Add Ines 138 136 13c, and 130 131 Total advances recele DO NOTEIE 139 Total deposits, deferrals and refundable credits advances Bet ne the 150 g 14 Balance due. If line 12 is more than line 139, enter the difference and see instructions 14 15 Overpayment. Wine 13g is more than Ine 12. enter the diference Check one Part 2 Tell us about your deposit schedule and tax liability for this quarter. you're unsure about whether you're a monthly schedule depositor or a serweekly schedule depositor, see section 11 of Pub. 15. Line 12 on this return is less than $2.500 or line 12 on the return for the prior quarter was less than $2,500. 16 Check one: and you didn't incur a $100.000 next day deposit bization during the current quarter Tine 12 for the prior federal tax lability. If you're a monthly schedule Sepouter complete e depot schedule below, youre a quarter was less than 2.5od but Ine 12 on this return $100.000 or more, you must provide a record of your semiwe schedule depositor, attach Schedule B Form 941). Go to Part 3 You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 Tax liability: Mont 1 Month 2 Month 3 Total liability for quarta Total must equal line 12 You were a semiwekly schedule depositor for any part of the quarter Complete Schedule Form 9411. Heport of Tax Liability for Serweakly Schedule Depositors, and attach it to Form 941. Go to Parta. You MUST complete all three pages of Form 941 and SIGN IL 202 F41 Plex 720201 Nemour de Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank 17 If your business has closed or you stopped paying wages enter the finaldate you paid wages also attach a statement to your return. See instructions 18 If you're a man ployer and you don't have to fin return for every quarter of the yea Check here and Check here TD Qualified health plan spend allocable to qualified sick leave wages 20 Qualified health plan expenses allocable to qualified family leave wages 21 Qualified wages for the employee retention credit Qualified health plant expenses allocable to wages reported on tine 23 Credit from Form 5684-0. Ane 11. for this quarter DO NOTEIN 24 Deferred amount of the employde share of social security to included on line 13b 25 Reserved for future use Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the RS? See the instructions for detalo Yes. Designe's name and phone number Select a 5-digit personal identification number Pin to seeking to the IRS NO. Part 5 Sign here. You MUST Complete all three pages of Fom 941 and SIGN IL Under porties of perjury declare that have endretum, rauding companying schedules are statements, and to the best of my and Belietis correct, and complete. Dederation of precather than peribadon formation of chwasanya Print your nama here Sign your name here title hare Print your Date Best daytime phone Pald Preparer Use Only Check if you're self-employed PTIN Preparar's signature F's name for you Data Address EIN City Phone DP code 941 Form 941-V, Payment Voucher app For plied nd Purpose of Form Complete Form 941-V If you're making a payment with Form 941. We will use the completed voucher to credit your payment mere end accurately, and to improve our service to you Making Payments with Form To avoid a penalty, make your payment with Form 941 only it: Your totales after ads credits (Foru the precedinguae TOP incur a $100.000 exchange current quarter, and you're paying in full with a timely filled retum or You're a monthly scheduledepoor mai payment in accordance with Accuracy Rule. See section 11 of Pub 15 for details the amount of your payment may be $2,500 or more Otherwise, you must make deposits by electronic funds transfer. See section 11 of Pub. 15 for deposit instructions. Don't use Form 941-V to make federal tax deposits Use Form 941-V when making any payment with Form 941. However, if you pay an amount with Form 941 that should've been deposited, you may be subject to a periarty. See Deposit Penalties in section 11 of Pub. 15. DONO Specific Instructions Box 1-Employer identification number (EIN. you don't have an N, you may apply for one online by visiting the website sw You may also ar Nayfaxing orman SS-4 to the hever recent you the due date of date you applied in this entry space Box 2-Amount paid. Enter the amount paid with Fo94 Box Tax period credenti the w which the only one orale Box 4-Name and address. Enter your name and dress as hown Form 941 Enclose your check or money ordenade payable to United States Tres Parter your EN "Form1.' and latex pered stuarter 2020, and Quarter 2020," "3rd Quarter 2020. or 4th Quarter 2020") on your check or money order. Don't send cash. Don't staple Form 941-Vor your payment to Form 941 for to each other) Detach Form 941-V and send it with your payment ard Form 941 to the address in the instructions for Form 941. Note: You must also complete the entity information above Part 1 on Form 941 OM 1545-00 De 2020 Detach Here and Mall With Your Payment and Form 941. 1941-V Payment Voucher Don't staple this voucher or your payment to Form 941 Euroyer encon num Enter the amount of your payment. Maloya korony ordered Balus 3 Tax Pertad 3rd Quarter Quarter Enter your address OO 2nd 16. Form 941. (Obj. 6) During the third quarter of 2020, the Fillmore Restaurant (EIN 931 0530660) located at 244 North Second Street, Fillmore, New York 14735-0022, withheld income and social security taxes from its five employees. It withheld income taxes of $3,117 from employees' wages and tips of $15,570. In addition, Fillmore withheld $912.95 of social security taxes on $17,725 of social security wages, and $52.39 of social security taxes on $845 of social security tips. It also withheld $225.77 of Medicare taxes on $15,570 of Medicare wages. During the quarter, Fillmore electronically deposited income and employment taxes as follows: August 15, $1,833.52; September 15, $1,790.26; October 15, $1,875.43. Data for quarterly wages and reported tips of employees is as follows: Name Total Wages Social Security Wages Taxable Tips Reported Barker, J. R. $ 7,025 $ 7,025 $315 Duwe, H. K. 3,000 3,000 Miller, M. M. 2,000 2,000 120 Pressman, R. M. 1,200 1,200 125 Smathers, H. H. 1,500 1,500 105 $14,725 $14,725 $845 180 Prepare the third quarter Form 941, Employer's QUARTERLY Federal Tax Return, for the Fillmore Restaurant, using the blank form provided on the pages that follow. Fillmore filed Form 941 and M. L. Wright, President, signed it on October 25, 2020. From 941 for 2020: Employer's QUARTERLY Federal Tax Return 950120 ONONO 1545-001 Rev. July 2020 Department of the Treasury - Internal Revenue Service Employer identification number EN Name that your trade nama Trade ramefany Report for this Quarter of 2020 Check 1. January February March 2. Ap. May, June 3: July August September 4: Ocrober November December Go to www.is.gov.lForm41 for instructions and the latest information CDRAFT AS August 28, 2020 Address Read the separate instructions before you complete Form 941. Type or print within the boxes Part 1: Answer these questions for this quarter. 1 Mumber of employees who received wages, tips, or other compensation for the pay period including: Sept. 12 (Quarter 3) or Dec 12 (Quarter 2 Wages, tips, and other compensaron 3 Federal income tax withheld from wages, tips, and other compensation Check and go to ling & 4 I no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 2 Ba Taxable social security wages x 0.124 ta Qualified sick leave wages x 0.062 5 Qualified family leave wages x 0.02 5b Taxable social security tips 0.134 50 Taxable Medicare wages & tips. x 0.029 5d Taxable wages & tips subject to Additional Medicare Tax withholding x 0.000 = I 5e Total social security and Medicare taxes. Add Column 2 from Ines 50, 5). Sall. 56, 5c, and 5d of Section 3121) Notice and Demand-Tax due on unreported tips (see instructional 5f 6 Total taxes before adjustments. Add lines 3, Se, and 5 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 & though 101 1ta Qualified small business payroll tax credit for increasing research activities Attach Form 2074 110 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 116 110 Nonrefundable portion of employee retention credit from Worksheet 1 110 You MUST complete all three pages of Form 941 and SIGN IL For Primacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat No. 170012 Fom 2000 Neend your trade name Part 1 Answer these questions for this quarter. continued 950220 11d Total nonrefundable credits. Add lines 114, 115, and 110 110 12 Total taxes after adjustments and nonrefundable credite Suburactie 11d homine 10 13a Total deposits for this quarter, eluding mment applied from end overpayment oppled from Form 91-941-X PR. 044-X, or 9-X (SP) in the wront quarter 13b Deferred amount of social security tax 13c Refundable portion of credit for mily leave wages from Worksheet 13d Rehindable portion of me 130 Total deposits, deferrals, and refundable credits. Add Ines 138 136 13c, and 130 131 Total advances recele DO NOTEIE 139 Total deposits, deferrals and refundable credits advances Bet ne the 150 g 14 Balance due. If line 12 is more than line 139, enter the difference and see instructions 14 15 Overpayment. Wine 13g is more than Ine 12. enter the diference Check one Part 2 Tell us about your deposit schedule and tax liability for this quarter. you're unsure about whether you're a monthly schedule depositor or a serweekly schedule depositor, see section 11 of Pub. 15. Line 12 on this return is less than $2.500 or line 12 on the return for the prior quarter was less than $2,500. 16 Check one: and you didn't incur a $100.000 next day deposit bization during the current quarter Tine 12 for the prior federal tax lability. If you're a monthly schedule Sepouter complete e depot schedule below, youre a quarter was less than 2.5od but Ine 12 on this return $100.000 or more, you must provide a record of your semiwe schedule depositor, attach Schedule B Form 941). Go to Part 3 You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 Tax liability: Mont 1 Month 2 Month 3 Total liability for quarta Total must equal line 12 You were a semiwekly schedule depositor for any part of the quarter Complete Schedule Form 9411. Heport of Tax Liability for Serweakly Schedule Depositors, and attach it to Form 941. Go to Parta. You MUST complete all three pages of Form 941 and SIGN IL 202 F41 Plex 720201 Nemour de Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank 17 If your business has closed or you stopped paying wages enter the finaldate you paid wages also attach a statement to your return. See instructions 18 If you're a man ployer and you don't have to fin return for every quarter of the yea Check here and Check here TD Qualified health plan spend allocable to qualified sick leave wages 20 Qualified health plan expenses allocable to qualified family leave wages 21 Qualified wages for the employee retention credit Qualified health plant expenses allocable to wages reported on tine 23 Credit from Form 5684-0. Ane 11. for this quarter DO NOTEIN 24 Deferred amount of the employde share of social security to included on line 13b 25 Reserved for future use Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the RS? See the instructions for detalo Yes. Designe's name and phone number Select a 5-digit personal identification number Pin to seeking to the IRS NO. Part 5 Sign here. You MUST Complete all three pages of Fom 941 and SIGN IL Under porties of perjury declare that have endretum, rauding companying schedules are statements, and to the best of my and Belietis correct, and complete. Dederation of precather than peribadon formation of chwasanya Print your nama here Sign your name here title hare Print your Date Best daytime phone Pald Preparer Use Only Check if you're self-employed PTIN Preparar's signature F's name for you Data Address EIN City Phone DP code 941 Form 941-V, Payment Voucher app For plied nd Purpose of Form Complete Form 941-V If you're making a payment with Form 941. We will use the completed voucher to credit your payment mere end accurately, and to improve our service to you Making Payments with Form To avoid a penalty, make your payment with Form 941 only it: Your totales after ads credits (Foru the precedinguae TOP incur a $100.000 exchange current quarter, and you're paying in full with a timely filled retum or You're a monthly scheduledepoor mai payment in accordance with Accuracy Rule. See section 11 of Pub 15 for details the amount of your payment may be $2,500 or more Otherwise, you must make deposits by electronic funds transfer. See section 11 of Pub. 15 for deposit instructions. Don't use Form 941-V to make federal tax deposits Use Form 941-V when making any payment with Form 941. However, if you pay an amount with Form 941 that should've been deposited, you may be subject to a periarty. See Deposit Penalties in section 11 of Pub. 15. DONO Specific Instructions Box 1-Employer identification number (EIN. you don't have an N, you may apply for one online by visiting the website sw You may also ar Nayfaxing orman SS-4 to the hever recent you the due date of date you applied in this entry space Box 2-Amount paid. Enter the amount paid with Fo94 Box Tax period credenti the w which the only one orale Box 4-Name and address. Enter your name and dress as hown Form 941 Enclose your check or money ordenade payable to United States Tres Parter your EN "Form1.' and latex pered stuarter 2020, and Quarter 2020," "3rd Quarter 2020. or 4th Quarter 2020") on your check or money order. Don't send cash. Don't staple Form 941-Vor your payment to Form 941 for to each other) Detach Form 941-V and send it with your payment ard Form 941 to the address in the instructions for Form 941. Note: You must also complete the entity information above Part 1 on Form 941 OM 1545-00 De 2020 Detach Here and Mall With Your Payment and Form 941. 1941-V Payment Voucher Don't staple this voucher or your payment to Form 941 Euroyer encon num Enter the amount of your payment. Maloya korony ordered Balus 3 Tax Pertad 3rd Quarter Quarter Enter your address OO 2nd
