3-11A 941 for 2 Employer'S QUARTERLY Federal Tax Return Report for this Quarter of 20-- CARLOS CRUZ 1:mary, February, March Name (nof your trade name Trade name fay CRUZ COMPANY 2Jdy, Apat, September October, November, December Adsress 901 KEYSTONE Instructions and prior year forms are CA 95916 SACRAMENTO . T Type or print within the wages, tips, or other compensation for the pay period boxes Read the separate instructions before you complete Form 941 Answer these questions for this quarter mber of employees who receved wagestips, or other including: Mar. 12 (Quarter 1), June 12 (Quarter 2). Wages, tips, and other compensation 1 Mar. 12 (Quarter 1),June t2 parter 2. Sept 12(Quarter 31, or Dec. 12 (Ou arter4) 2 3 Federal income tax withheld from wages, tips, and other and other compensation are subject to social security or Medicare tax Check and go to lines If no wages, tips, a Column 1 Column 2 x.124 Sa Taxable social security wages .. 5b Taxable social security tips 5c Taxable Medicare wages & tips. .124 " subject to Taxable wages & tip Additional Medicare Tax withholding 5d x009 , Se Add Column 2 from lines 5a, 5b, 5c, and Sd 5f Section 3121(q) Notice and Demand-Tax due on unreported tips (see inctructions 6 Total taxes before adjustments. Add lines 3, 5e, and 5 7 Current quarter's adjustment for fractions of cents 5e 8 Current quarter's adjustment for sick pay 9 10 Total taxes after adjustments. Combine lines 6 through 9 11 Total deposits for this quarter, including overpayment applied from a prior quarter and Current quarter's adjustments for tips and group-term lite nsu 10 overpayments applied from Form 941-X, 941-X (PR), 944-x, 944-X (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 Overpayment. If line 11 is more than line 10, enter the difference You MUST complete both pages of Form 941 and SIGN it 13 |Check one: Apply to rent- - Send aretnd. For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher Form 941 (Re. 1-2015