EMPLOYER'S REPORTOF STATE INCOME TAX WITHHELD1 DO NOT WRITE IN THIS SPACEIMPORTANT . PLEASE DEFERTO THIS NUMBER IN ACT00-0-8787DEC 20--GROSS PAYROLL THISIF YOU ARE A SEA-SONALEMPLOYERAND THIS IS YOURFINAL REPORT FORCLARKE'S ROOFINGTHIS SEASON, CHECK20 SUMMIT SQUAREHEREO AND SHOW THECITY, STATE 00000-0000NEXT MONTH INWHICH YOU WILLPAY WAGES.IF NAME ON ADDRESS IN INCORRECT, PLEASE WAKE CORRECTIONS.PENALTY (35% OF LINE A)THIS REPORT MUST BE RETURNED EVEN IF NO AMOUNT HAS BEEN WITHHELDTOTAL AMOUNT DUEAND PATROLMAIL THIS REPORT WITH CHECK OR MONET ORDER PAYABLE TOTHE DEPT. OF REVENUE ON OR BEFORE DUE DATE TO AVOIDSIGNATURE:TITLE:DATEPENALTY. FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number _00-0004701 Name CLARKE'S ROOFINGMonth Tax Year Ends 12 Amount of Deposit Type of Tax (Form) Tax Period Address 20 SUMMIT SQUARE Phone Number Gity, State, Zip CITY, STATE 00000-0000 To be deposited on or before Form 341 Tor ZU--: Employer's QUARTERLY Federal Tax Return(Rev. April 2020]Department of the Treasury - Internal Revenue ServiceOMB No. 1545-0029Employer identification number (FIN00Report for this Quarter of 20--Check one.|Name (not your trade nameCLARKE'S ROOFING1: January, February, March2: April, May, JuneTrade name of any3: July, August, SeptemberAddress20 SUMMIT SQUARE4: October, November, DecemberNumberStreetSuite or room numberGo to www.irs.gowForm941 forCITYST00000-0000instructions and the latest information.CitySimicForeign country nameForeign province countyForeign postal codeRead the separate instructions before you complete Form 941. Type or print within the boxes.Part 1:Answer these questions for this quarter.1Number of employees who received wages, tips, or other compensation for the payperiod including: June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)2Wages, tips, and other compensation23 Federal income tax withheld from wages, tips, and other compensation34If no wages, tips, and other compensation are subject to social security or Medicare taxCheck and go to line 6.Column 1Column 25a Taxable social security wages* 0.124 =5a () Qualified sick leave wages* 0.062 =5a (ii) Qualified family leave wages