Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30,20. Using the information presented below, complete Part 1 of form 941. - I of employees for pay period that included September 12=14 employees - Wages paid third quarter =$79,750.17 - Taxable social security and Medicare wages =$79,750,17 Total tax deposits for the quarter =$21,771.83 line 7 as a deduction or an addition as "Fractions of Cents: employee's earning plus the employer's payroll tax amounts each pay. If an input box does not require an entry, leave it blank. When required, round amounts to the nearest cent. Tam 941 for 20-: Employer's QUARTERLY Federal Tax Return INav, Haze 21213) Bert 14 Answer theak questions for this quartar. 1. Number of amploysus wha receivid wages, tips, or other compensatian for the pay period inciuding: Mar. 12 (Quartar 1), Jume 12 (Quartar 2), Sept. 12 (Quartar 3), or Dac. 12 (quarter 4 ).. 2. Wages, tipi, and other eamporsation 3 Federal inceme tax withheld frem wages, tips, and ather compursation ....................... 3 4 if no wages, tips, and ether enmpumsation ars subjuct te social socurity ar Medicara tarn: Se Total social aecurity and Medicare taxss. Add Column 2 from linisi, 5a, 5a(0, 5a(i),5h,5c, arid 5d. If Section 3121(a) Natice and Demand-Tax due ea unraported lips (wone inatrataions) - 6. Total texes befork adjustments. Adet lites 3, Ses, and 5r. 7. Curnant equartar's adjuastment for fractions of cents. 8 Currant quartar's adjustment for aick pay . 2. Current quarter's adjustments fur tips and group-tarm lifie inkurance. 10 Tetal taxes aftur adjuatmants, Cumtme finks 6 thrusgh 4. 5se 11b Narirafundable pertian of crudit for qualifide aick and family leave mages from Workahest.1....... 11b I1e Nunarafuable pertion of emplayee rutention cradit fram Workahest 1 11c Yau Must cumplete all threk pages of Furm 241 and stek it. For Primacy Act and Paperwark iEeductian Act Notice, sed thw back of the Payment Vaucher. \begin{tabular}{l|c} \hline Name (not your trade name) & Employer identification number (EIN) \\ CARLOS CRUZ & 000006509 \\ \hline \end{tabular} Part 1: Answer these questions for this quarter. (continued) 12 Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10....12 13a Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments 13 a applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter. 13b Reserved for the future use. 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 ......... 13c 13d Refundable portion of employee retention credit from Worksheet 1.....13d 13e Total deposits and refundable credits. Add lines 13a,13c, and 13d. 13f Total advances received from filing Form(s) 7200 for the quarter 13g Total deposits and refundable credits less advances. 5 ubtract line 13f from line 13e.....13g 14 Balance due. If line 12 is more than line 13g, enter the difference and see instructions ............... 14 15 Overpayment. If line 13g is more than line 12 , enter the difference Check one: Apply to next return, Send a refund. Page 2 Form 941 (Rev. 3-2021) Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30,20. Using the information presented below, complete Part 1 of form 941. - I of employees for pay period that included September 12=14 employees - Wages paid third quarter =$79,750.17 - Taxable social security and Medicare wages =$79,750,17 Total tax deposits for the quarter =$21,771.83 line 7 as a deduction or an addition as "Fractions of Cents: employee's earning plus the employer's payroll tax amounts each pay. If an input box does not require an entry, leave it blank. When required, round amounts to the nearest cent. Tam 941 for 20-: Employer's QUARTERLY Federal Tax Return INav, Haze 21213) Bert 14 Answer theak questions for this quartar. 1. Number of amploysus wha receivid wages, tips, or other compensatian for the pay period inciuding: Mar. 12 (Quartar 1), Jume 12 (Quartar 2), Sept. 12 (Quartar 3), or Dac. 12 (quarter 4 ).. 2. Wages, tipi, and other eamporsation 3 Federal inceme tax withheld frem wages, tips, and ather compursation ....................... 3 4 if no wages, tips, and ether enmpumsation ars subjuct te social socurity ar Medicara tarn: Se Total social aecurity and Medicare taxss. Add Column 2 from linisi, 5a, 5a(0, 5a(i),5h,5c, arid 5d. If Section 3121(a) Natice and Demand-Tax due ea unraported lips (wone inatrataions) - 6. Total texes befork adjustments. Adet lites 3, Ses, and 5r. 7. Curnant equartar's adjuastment for fractions of cents. 8 Currant quartar's adjustment for aick pay . 2. Current quarter's adjustments fur tips and group-tarm lifie inkurance. 10 Tetal taxes aftur adjuatmants, Cumtme finks 6 thrusgh 4. 5se 11b Narirafundable pertian of crudit for qualifide aick and family leave mages from Workahest.1....... 11b I1e Nunarafuable pertion of emplayee rutention cradit fram Workahest 1 11c Yau Must cumplete all threk pages of Furm 241 and stek it. For Primacy Act and Paperwark iEeductian Act Notice, sed thw back of the Payment Vaucher. \begin{tabular}{l|c} \hline Name (not your trade name) & Employer identification number (EIN) \\ CARLOS CRUZ & 000006509 \\ \hline \end{tabular} Part 1: Answer these questions for this quarter. (continued) 12 Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10....12 13a Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments 13 a applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter. 13b Reserved for the future use. 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 ......... 13c 13d Refundable portion of employee retention credit from Worksheet 1.....13d 13e Total deposits and refundable credits. Add lines 13a,13c, and 13d. 13f Total advances received from filing Form(s) 7200 for the quarter 13g Total deposits and refundable credits less advances. 5 ubtract line 13f from line 13e.....13g 14 Balance due. If line 12 is more than line 13g, enter the difference and see instructions ............... 14 15 Overpayment. If line 13g is more than line 12 , enter the difference Check one: Apply to next return, Send a refund. Page 2 Form 941 (Rev. 3-2021)