Cruz Company has gathered the information needed to complete its Form 941 for the quarter ended September 30, 2017. They are a monthly depositor with the following monthly tax liabilities for this quarter:

July	$7,193.10
August	7,000.95
September	7,577.78

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).

Complete Parts 2, 4, and 5 of Form 941 for Cruz Company for the third quarter of 2017.

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

Part 2:

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

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

14 Check one:

a.

Line 10 on this return is less than $2,500 or line 10 on the return for the prior quarter was less than $2,500, and you did not incur a $100,000 next-day deposit obligation during the current quarter. If line 10 for the prior quarter was less than $2,500 but line 10 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are 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
	Month 2
	Month 3
Total liability for quarter			Total must equal line 10.

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.

Part 3:

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

15

If your business has closed or you stopped paying wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Check here, and
enter the final date you paid wages	/ /	.

16

If you are a seasonal employer and you do not have to file a return for every quarter of the year . . . . . . . . . . . . . . . . . Check here.

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.

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 both 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

Print your name here

Print your title here

Date

10/31/17

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 2

Form 941 (Rev. 1-2016) Source: Internal Revenue Service

Check My Work

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