DIANE R$.$ PETERS

$00-0003607$

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

$\frac{1}{1}$

; 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.

$19$ Qualifled health plan expenses allocable to qualifled sick leave wages for leave taken before Aprll $1,2021$

$19$

$20$ Qualifled health plan expenses allocable to qualifled family leave wages for leave taken before April $1,2021$

$20$

$21$ Reserved for future use

$21$

$22$ Reserved for future use

$22$

$23$ Qualifled sick leave wages for leave taken after March $31,2021,$ and before October $1,2021$dotsdots$23$

$24$ Qualifled health plan expenses allocable to qualified sick leave wages reported on line $23.......24$

$25$ Amounts under certain collectively bargained agreements allocable to qualified sick leave wages reported on line $23.$

$26$ Qualified family leave wages for leave taken after March $31,2021,$ and before October $1,2021$dotsdots$26$

$27$ Qualified health plan expenses allocable to qualified family leave wages reported on line $26$dots....$\mathrm{.}27$

$2$ more Check My Work uses remaining: