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.

Note: Round all values to the nearest cent. Use minus sign to indicate a deduction. If line 7 is zero, for grading purposes only, enter a zero.

• # of employees for pay period that included September 12 = 14 employees
• Wages paid third quarter = $80,736.24
• Federal income tax withheld in the third quarter = $9,688.35
• Taxable social security and Medicare wages = $80,736.24
• Total tax deposits for the quarter = $22,040.99

Note: Lines 5a and 5c of Form 941, tax on total taxable wages, are computed by multiplying by the combined tax rate for both employer and employee. Small differences due to rounding may occur between this total and the total taxes withheld from employees each pay period and the amount of the employer's taxes calculated each pay period. This difference is reported on line 7 as a deduction or an addition as "Fractions of Cents."

Hint: Line 7 instructions. Fill in Form 941 through line 6, and then fill in Part 2, line 16, Schedule B. Take that information and fill in line 10. Note that Lines 6 and 10 must equal. If the amounts are not the same, correct by entering amount to make equal on line 7. Line 7 differences are caused by how calculations are made on Form 941 and the amounts withheld from employee's earning plus the employer's payroll tax amounts each pay.

Form 941 for 20--: (Rev. April 2020)

Employer's QUARTERLY Federal Tax Return Department of the Treasury Internal Revenue Service

OMB No. 1545-0029

Employer identification number (EIN)

0

0

0

0

0

6

5

0

9

Name (not your trade name)

CARLOS CRUZ

Trade name (if any)

CRUZ COMPANY

Address

901 KEYSTONE

Number

Street

Suite or room number

SACRAMENTO

CA

95916

City

State

ZIP code

Foreign country name

Foreign province/county

Foreign postal code

Report for this Quarter of 20-- (Select one.)

January, February, MarchApril, May, JuneJuly, August, SeptemberOctober, November, December

Go to www.irs.gov/Form941 for instructions and the latest information.

Read the separate instructions before you complete Form 941. Type or print within the boxes.

Part 1:

Answer these questions for this quarter.

1

Number of employees who received wages, tips, or other compensation for the pay period including: June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

fill in the blank 2

2

Wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

fill in the blank 3

3

Federal income tax withheld from wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . .

3

fill in the blank 4

4

If no wages, tips, and other compensation are subject to social security or Medicare tax

Check and go to line 6.

		Column 1		Column 2
5a	Taxable social security wages . . . . . . . . . . . .	fill in the blank 5	x 0.124 =	fill in the blank 6
5a	(i) Qualified sick leave wages . . . . . . . . . . . .	fill in the blank 7	x 0.062 =	fill in the blank 8
5a	(ii) Qualified family leave wages . . . . . . . . .	fill in the blank 9	x 0.062 =	fill in the blank 10
5b	Taxable social security tips . . . . . . . . . . . . . .	fill in the blank 11	x 0.124 =	fill in the blank 12
5c	Taxable Medicare wages & tips . . . . . . . . . . .	fill in the blank 13	x 0.029 =	fill in the blank 14
5d	Taxable wages & tips subject to Additional Medicare Tax withholding	fill in the blank 15	x 0.009 =	fill in the blank 16

5e

Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d . . . . . . . .

5e

fill in the blank 17

5f

Section 3121(q) Notice and DemandTax due on unreported tips (see instructions) . . . . . . . . . . . . . . . .

5f

fill in the blank 18

6

Total taxes before adjustments. Add lines 3, 5e, and 5f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

fill in the blank 19

7

Current quarter's adjustment for fractions of cents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

fill in the blank 20

8

Current quarter's adjustment for sick pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

fill in the blank 21

9

Current quarter's adjustments for tips and group-term life insurance . . . . . . . . . . . . . . . . . . . . . . . . . .

9

fill in the blank 22

10

Total taxes after adjustments. Combine lines 6 through 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

fill in the blank 23

11a

Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 . . . . . . .

11a

fill in the blank 24

11b

Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 . . . . . . .

11b

fill in the blank 25

11c

Nonrefundable portion of employee retention credit from Worksheet 1 . . . . . . . . . . . . . . . . . . . . . . . .

11c

fill in the blank 26

You MUST complete all three pages of Form 941 and SIGN it.

Next

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

Cat. No. 17001Z

Form 941 (Rev. 4-2020)

Name (not your trade name)	Employer identification number (EIN)
CARLOS CRUZ	00-0006509

Part 1:

Answer these questions for this quarter. (continued)

11d	Total nonrefundable credits. Add lines 11a, 11b, and 11c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	11d	fill in the blank 27
12	Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10 . . . . . . . . . . . . .	12	fill in the blank 28
13a	Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter . . . . . . . . . . .	13a	fill in the blank 29
13b	Deferred amount of the employer share of social security tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	13b	fill in the blank 30
13c	Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 . . . . . . . . . . .	13c	fill in the blank 31
13d	Refundable portion of employee retention credit from Worksheet 1 . . . . . . . . . . . . . . . . . . . . . . . . . . .	13d	fill in the blank 32
13e	Total deposits, deferrals, and refundable credits. Add lines 13a, 13b, 13c, and 13d . . . . . . . . . . . . . . . . . .	13e	fill in the blank 33
13f	Total advances received from filing Form(s) 7200 for the quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	13f	fill in the blank 34
13g	Total deposits, deferrals, and refundable credits less advances. Subtract line 13f from line 13e . . . . . . . .	13g	fill in the blank 35
14	Balance due. If line 12 is more than line 13g, enter the difference and see instructions . . . . . . . . . . . . . . . . . .	14	fill in the blank 36
15	Overpayment. If line 13g is more than line 12, enter the difference fill in the blank 37 Check one: Apply to next return. Send a refund.

Page 2

Form 941 (Rev. 4-2020)