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. | | | | | | 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 | | | ZIP code | | Page 2 | Form 941 (Rev. 1-2016) Source: Internal Revenue Service | |