complete the form:
wage = 39523.76
income tax withheld = 3471.45
social security tax withheld = 3163.01
medicare tax withheld = 679.96
Print Form FORM 941 V.I. (REV. 05/2012) Government of the U. S. Virgin Islands BUREAU OF INTERNAL REVENUE Employer's Quarterly Virgin Islands Tax Return Befer to Publication 15 or the Circular E for ling Eequirements- zee reverse for instructions Employer Identification Number (EIN) 20 66-1234567 Name (as distinguished from tradename) Orkin Extirminating, Inc TAX PERIOD Cbeck only coe quarter 1st QTR. 3RD QTR. Ends: MAR 31Ends: SEPT. 30 Due: APR. 30 Due: OCT. 31 Mailing Address ND QTR.4TH QTR. (APR-MAY-JUN Ends: JUN. 30 OCT-Nov Ends: DEC. 31 State p Code Due: JUL. 31 Due: JAN 31 A Indicate your principal business activity code (SEE REVERSE) B. If you do not have to file returns in the future, check here Indicate Firm Type: Sole Proprietor and enter date final wages were paid (mm dd yy) C. If you are a seasonal employer, check here 1.) Number of Employees (except household) employed during the quarter 2) Total Wages, Tips, plus other compensation. 3.) Total income tax withheld from wages, tips, &sick pay.3 4.) Adjustment of withheld income tax for preceding quarters of Corporation 39,523.76 833.40 calendar year. 5.) Adjusted total of income tax withheld (line 3 adjusted by line 4) 6.) Advanced eaned income credit (EIC) payments made to 5 employees, if any 7) NET TAYES (subtract line 6 from line 5) THIS SHOULD EQUAL LINE 11 COLUMND) BELOW 8.) Total deposits for the quarter, including overpayment applied from prior quarter 9) Balance Due to be paid with this return (7- 8) 10.) Overpayment, if line 8 is more than line 7, enter excess $ here 10 And check if to be: Applied to next retun or Refiunded. MONTHLY SUMMARY OF TAX LIABILITY SEE BACK OF FORI FOR SPECIAL INSTRUCTIONS REGARDING LINES 11& 12 (a) lst month liability (b) 2nd month liability (c) 3d month liability (d) Total Liability for 12.) Check if you are a semiweekly depositor Complete and attach Schedule B (Form 941VI). I declare under pnalties of perjury thet I have examined this reum (ncluding the acconpanying schechiles and statements) and to the best of my knowledge and belief is true, correct, and conplere Orkin Exterminating, Inc TITLE SIGNATURE DATE Telephone: Form 941VI (05/2012) Print Form FORM 941 V.I. (REV. 05/2012) Government of the U. S. Virgin Islands BUREAU OF INTERNAL REVENUE Employer's Quarterly Virgin Islands Tax Return Befer to Publication 15 or the Circular E for ling Eequirements- zee reverse for instructions Employer Identification Number (EIN) 20 66-1234567 Name (as distinguished from tradename) Orkin Extirminating, Inc TAX PERIOD Cbeck only coe quarter 1st QTR. 3RD QTR. Ends: MAR 31Ends: SEPT. 30 Due: APR. 30 Due: OCT. 31 Mailing Address ND QTR.4TH QTR. (APR-MAY-JUN Ends: JUN. 30 OCT-Nov Ends: DEC. 31 State p Code Due: JUL. 31 Due: JAN 31 A Indicate your principal business activity code (SEE REVERSE) B. If you do not have to file returns in the future, check here Indicate Firm Type: Sole Proprietor and enter date final wages were paid (mm dd yy) C. If you are a seasonal employer, check here 1.) Number of Employees (except household) employed during the quarter 2) Total Wages, Tips, plus other compensation. 3.) Total income tax withheld from wages, tips, &sick pay.3 4.) Adjustment of withheld income tax for preceding quarters of Corporation 39,523.76 833.40 calendar year. 5.) Adjusted total of income tax withheld (line 3 adjusted by line 4) 6.) Advanced eaned income credit (EIC) payments made to 5 employees, if any 7) NET TAYES (subtract line 6 from line 5) THIS SHOULD EQUAL LINE 11 COLUMND) BELOW 8.) Total deposits for the quarter, including overpayment applied from prior quarter 9) Balance Due to be paid with this return (7- 8) 10.) Overpayment, if line 8 is more than line 7, enter excess $ here 10 And check if to be: Applied to next retun or Refiunded. MONTHLY SUMMARY OF TAX LIABILITY SEE BACK OF FORI FOR SPECIAL INSTRUCTIONS REGARDING LINES 11& 12 (a) lst month liability (b) 2nd month liability (c) 3d month liability (d) Total Liability for 12.) Check if you are a semiweekly depositor Complete and attach Schedule B (Form 941VI). I declare under pnalties of perjury thet I have examined this reum (ncluding the acconpanying schechiles and statements) and to the best of my knowledge and belief is true, correct, and conplere Orkin Exterminating, Inc TITLE SIGNATURE DATE Telephone: Form 941VI (05/2012)
