Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30, 20 They are a monthly depositor with the following monthly tax liabilities for this quarter July $7,137 80 August 6,819 40 September 8,083 66 State unemployment taxes are only paid to California The company does not use a third party designee and the tax returns are signed by the president, Carlos Cruz (Phone 916 555 9739), and the date filed is October 31, 20 Complete Parts 2, 4, and 5 of Form 941 for Cruz Company for the third quarter of 20 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 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 applied from Form 941 X, 941 X (PR), 944 X, or 944 X (SP) filed in the current quarter 13a 13b Deferred amount of the employer share of social security tax 13b 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, deferrals, and refundable credits Add lines 13a, 13b, 13c, and 13d 13e 13f Total advances received from filing Form(s) 7200 for the quarter 13f 13g Total deposits, deferrals, and refundable credits less advances Subtract 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 Part 2 Tell us about your deposit schedule and tax liability for this quarter If you're unsure about whether you're a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub 15 16 Check one abc a Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next day deposit obligation during the current quarter If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability If you're a monthly schedule depositor, complete the deposit schedule below if you're a semiweekly schedule depositor, attach Schedule B (Form 941) Go to Part 3 b You were a monthly schedule depositor for the entire quarter Enter your tax liability for each month and total liability for the quarter, then go to Part 3 Tax liability Month 1 fill in the blank 2 Month 2 fill in the blank 3 Month 3 fill in the blank 4 Total liability for quarter fill in the blank 5 Total must equal line 12 c You were a semiweekly schedule depositor for any part of this quarter Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941 You MUST complete all three pages of Form 941 and SIGN it Next Page 2 Form 941 (Rev 4 2020) Name (not your trade name) Employer identification number (EIN) CARLOS CRUZ 00 0006509 Part 3 Tell us about your business If a question does NOT apply to your business, leave it blank 17 If your business has closed or you stopped paying wages Check here, and enter the final date you paid wages also attach a statement to your return See instructions 18 If you're a seasonal employer and you don't have to file a return for every quarter of the year Check here 19 Qualified health plan expenses allocable to qualified sick leave wages 19 20 Qualified health plan expenses allocable to qualified family leave wages 20 21 Qualified wages for the employee retention credit 21 22 Qualified health plan expenses allocable to wages reported on line 21 22 23 Credit from Form 5884 C, line 11, for this quarter 23 24 Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this line only for the second quarter filing of Form 941) 24 25 Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the second quarter filing of Form 941) 25 Part 4 May we speak with your third party designee Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS See the instructions for details YesNo Designee's name and phone number Select a 5 digit Personal Identification Number (PIN) to use when talking to the IRS Part 5 Sign here You MUST complete all three pages of Form 941 and SIGN it Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Sign your name here Carlos Cruz Print your name here Carlos Cruz Print your title here President Date 10 31 Best daytime phone 916 555 9739 Paid Preparer Use Only Check if you are self employed Preparer's name PTIN Preparer's signature Date Firm's name (or yours if self employed) EIN Address Phone City State ZIP code Page 3 Form 941 (Rev 4 2020) Source Internal Revenue Service

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Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30, 20--. They are a monthly depositor with

Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30, 20--. They are a monthly depositor with the following monthly tax liabilities for this quarter:

July	$7,137.80
August	6,819.40
September	8,083.66

State unemployment taxes are only paid to California. The company does not use a third-party designee and the tax returns are signed by the president, Carlos Cruz (Phone: 916-555-9739), and the date filed is October 31, 20--.

Complete Parts 2, 4, and 5 of Form 941 for Cruz Company for the third quarter of 20--.

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
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 applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter . . . . . . . . . . .	13a
13b	Deferred amount of the employer share of social security tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	13b
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, deferrals, and refundable credits. Add lines 13a, 13b, 13c, and 13d . . . . . . . . . . . . . . . . . .	13e
13f	Total advances received from filing Form(s) 7200 for the quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	13f
13g	Total deposits, deferrals, and refundable credits less advances. Subtract 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.

Part 2:

Tell us about your deposit schedule and tax liability for this quarter.

If you're unsure about whether you're a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15.

16 Check one:

abc

Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you're a monthly schedule depositor, complete the deposit schedule below; if you're a semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.

You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3.

Tax liability:	Month 1	fill in the blank 2
	Month 2	fill in the blank 3
	Month 3	fill in the blank 4
Total liability for quarter		fill in the blank 5	Total must equal line 12.

You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.

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

Next

Page 2

Form 941 (Rev. 4-2020)

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

Part 3:

Tell us about your business. If a question does NOT apply to your business, leave it blank.

If your business has closed or you stopped paying wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Check here, and
enter the final date you paid wages	/ /	; also attach a statement to your return. See instructions.

If you're a seasonal employer and you don't have to file a return for every quarter of the year . . . . . . . . . . . . . . . . . . Check here.

19	Qualified health plan expenses allocable to qualified sick leave wages . . . . . . . . . . . . . . . . . . . . . . . . . .	19
20	Qualified health plan expenses allocable to qualified family leave wages . . . . . . . . . . . . . . . . . . . . . . . .	20
21	Qualified wages for the employee retention credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	21
22	Qualified health plan expenses allocable to wages reported on line 21 . . . . . . . . . . . . . . . . . . . . . . . . . .	22
23	Credit from Form 5884-C, line 11, for this quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	23
24	Qualified wages paid March 13 through March 31, 2020, for the employee retention credit (use this line only for the second quarter filing of Form 941) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	24
25	Qualified health plan expenses allocable to wages reported on line 24 (use this line only for the second quarter filing of Form 941) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	25

Part 4:

May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details.

YesNo

Designee's name and phone number

Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS.

Part 5:

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

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign your name here

Carlos Cruz

Print your name here

Carlos Cruz

Print your title here

President

Date

10/31/--

Best daytime phone

916-555-9739

Paid Preparer Use Only

Check if you are self-employed . . . .