Drew Freeman operates a small business and his payroll records for the first quarter of 2019 reflect the following:

Employee	Matt D.		Jack F.		Avery F.		Tiffany Y.
Gross wages	$2,870.00		$1,400.00		$1,750.00		$4,200.00
Federal income tax withheld	37.00		18.00		24.00		191.00
FICA taxes	439.11		214.20		267.75		642.60

Drew's employee identification number is 34-4321321 and his business is located at 732 Nob Hill Blvd. in Yakima, WA 98902. Drew is eligible to pay his withholding at the time he files his quarterly Form 941.

Complete page 1 of Form 941 for Drew for the first quarter of 2019. If your answer is zero, enter "0". Round your answers to two decimal places, if necessary.

Form 941 for 2019: (Rev. January 2019)

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

950117 OMB No. 1545-0029

Employer identification number (EIN)

3

4

4

3

2

1

3

2

1

Name (not your trade name)

Drew Freeman

Trade name (if any)

Address

732 Nob Hill Blvd.

Number

Street

Suite or room number

Yakima

WA

98902

City

State

ZIP code

Foreign country name

Foreign province/county

Foreign postal code

Report for this Quarter of 2019 (Check one.)

1:	January, February, March
2:	April, May, June
3:	July, August, September
4:	October, 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: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)

1

2

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

2

3

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

3

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 . . . . .		x 0.124 =
5b	Taxable social security tips . . . . . . . .		x 0.124 =
5c	Taxable Medicare wages & tips . . . . .		x 0.029 =
5d	Taxable wages & tips subject to Additional Medicare Tax withholding		x 0.009 =

5e

Add Column 2 from lines 5a, 5b, 5c, and 5d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5e

5f

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

5f

6

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

6

7

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

7

8

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

8

9

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

9

10

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

10

11

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

11

12

Total taxes after adjustments and credits. Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . .

12

13

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 . . . . . . . . . . .

13

14

Balance due. If line 12 is more than line 13, enter the difference and see instructions . . . . . . . . . . . . . . . . . . .

14

15

Overpayment. If line 13 is more than line 12, enter the difference Check one: Apply to next return. Send a refund.

You MUST complete both 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. 1-2019)