During the third calendar quarter of 20--, Bayview Inn, owned by Diane R. Peters, employed the persons listed below. Also given are the employees' salaries or wages and the amount of tips reported to the owner. The tips were reported by the 10th of each month. The federal income tax and FICA tax to be withheld from the tips were estimated by the owner and withheld equally over the 13 weekly pay periods. The employer's portion of FICA tax on the tips was estimated as the same amount.

Employee		Salary or Wage		Quarter's Wages		Quarter's Tips		Quarter's OASDI		Quarter's HI		Quarter's FIT
Grant Frazier		$78,000/year		$19,500.00				$1,209.00		$282.75		$1,500.00
Joseph LaVange		52,000/year		13,000.00				806.00		188.50		1,100.00
Susanne Ayers		800/week		10,400.00		$2,240.90		783.77		183.30		750.00
Howard Cohen		650/week		8,450.00		2,493.10		678.47		158.73		740.00
Lee Soong		675/week		8,775.00		2,640.30		707.72		165.49		660.00
Mary Yee		750/week		9,750.00		2,704.00		772.20		180.70		900.00
Helen Woods		750/week		9,750.00				604.50		141.44		800.00
Koo Shin		600/week		7,800.00				483.60		113.10		1,100.00
Aaron Abalis		750/week		9,750.00				604.50		141.44		800.00
David Harad		600/week		7,800.00				483.60		113.10		750.00
				$104,975.00		$10,078.30		$7,133.36		$1,668.55		$9,100.00

Employees are paid weekly on Friday. The following paydays occurred during this quarter:

July		August		September
5 weekly paydays		4 weekly paydays		4 weekly paydays

Taxes withheld for the 13 paydays in the third quarter follow:

Employees	Weekly			Weekly
Federal Income Tax	FICA Taxes Withheld on Wages			FICA Taxes on Tips
	OASDI		HI	OASDI		HI
$700 per week	Employees'	$500.65	$117.11	Employees'	$48.07	$11.24
	Employer's	500.65	117.09	Employer's	48.07	11.24

Based on the information given, complete Form 941 on the following pages for Diane R. Peters. Phone number: (901) 555-7959 Date filed: October 31, 20--

Note: Lines 5a and 5c of Form 941, tax on total taxable wages, are computed by multiplying by the combined tax rate for both employer and employee.

Small differences due to rounding may occur between this total and the total taxes withheld from employees each pay period and the amount of the employer's taxes calculated each pay period. This difference is reported on line 7 as a deduction or an addition as "Fractions of Cents."

If a box does not require an amount, leave it blank. If required, round your answers to nearest cent. Use a minus sign to indicate a deduction. Assume that company deposits taxes on monthly basis.