3-14A LO 5See pages 3-22 and 3-23

During the third calendar quarter of 20--, Bayview Inn, owned by Diane R. Peters, employed the persons listed below. Also given are the employees' salaries or wages and the amount of tips reported to the owner. The tips were reported by the 10th of each month. The federal income tax and FICA tax to be withheld from the tips were estimated by the owner and withheld equally over the 13 weekly pay periods. The employer's portion of FICA tax on the tips was estimated as the same amount.

Employees are paid weekly on Friday. The following paydays occurred during this quarter:

July

August

September

5 weekly paydays

4 weekly paydays

4 weekly paydays

Taxes withheld for the 13 paydays in the third quarter follow:

Employees' Federal Income Tax

Weekly FICA Taxes Withheld on Wages

Weekly FICA Taxes on Tips

OASDI

HI

OASDI

HI

$700 per week

Employees' $500.65

$117.11

Employees' $48.07

$11.24

Employer's 500.65

117.09

Employer's 48.07

11.24

Based on the information given, complete Form 941 on the following pages for Diane R. Peters. Phone number: (901) 555-7959