Figure 3.8 During the fourth quarter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. Using the forms supplied below, complete the following forms for the fourth quarter. If an amount or input box does not require an entry, leave it blank or enter "O". Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $18,630.00 $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For this edition, the 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been used. a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET - Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 Type of Tax (Form) 941 Tax Period 4th quarter Figure 3.8 During the fourth quarter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. U- below, complete the following forms for the fourth quarter. If an amount or input box does not require an entry, leave it blank or enter "O". Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $18,630.00 $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 941 Tax Period Type of Tax (Form) 4th quarter erter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. Using the forms supplied Following forms for the fourth quarter. ut box does not require an entry, leave it blank or enter "0". Quarterly Payroll Data OASDI HI FIT SIT $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 270.14 each pay 673.34 e federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For this edition, the Eax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been used. Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET 00-0004701 Name QUALITY REPAIRS 12 Amount of Deposit 1,346.68 941 Tax Period 4th quarter Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 $18,630.00 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET Employer 00-0004701 Name Identification Number QUALITY REPAIRS 12 Amount of Deposit 1,346.68 Month Tax Year Ends 941 Tax Period 4th quarter Type of Tax (Form) 10 SUMMIT SQUARE Phone Number Address (501) 555-7331 City, State, ZIP CITY, STATE 00000-0000 To be deposited on or before November 15, 20-- FEDERAL DEPOSIT INFORMATION WORKSHEET FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 X Type of Tax (Form) 941 Tax Period 4th quarter Address 10 SUMMIT SQUARE Phone Number (501) 555-7331 City, State, ZIP CITY, STATE 00000-0000 To be deposited on or before December 15, 20-- FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 Type of Tax (Form) 941 Tax Period 4th quarter Address 10 SUMMIT SQUARE Phone Number (501) 555-7331 City, State, ZIP CITY, STATE 00000-000 To be deposited on or before January 15, 20-- b. Employer's Quarterly Federal Tax Return, Form 941. The form is signed by you as president on January 31, 20--, Hint: Line 7 instructions. Fill in Form 941 through line 6, and then fill in Part 2, line 16 or Schedule B. Take that information and fill in line 10. Lines 6 and 10 must equa amounts are not the same, correct by entering amount to make equal on line 7. Line 7 differences are caused by how calculations are made on Form 941 and the amounts from employee's earning plus the employer's payroll tax amounts each pay. Form 941 for 20-- Employer's QUARTERLY Federal Tax Return (Rev. March 2021) Department of the Treasury - Internal Revenue Service OMB No. 1545-0029 Employer identification number (EIN) 0 0 0 0 0 4 7 o 1 Name (not your trade name) QUALITY REPAIRS Report for this Quarter of 20-- (Select one.) October, November, December Go to www.irs.gov/Form 941 for instructions and the latest information. Trade name (if any) Address 10 SUMMIT SQUARE Number Street Suite or room number CITY ST 00000-0000 City State ZIP code Foreign country name Foreign province/county Foreign postal code Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1; Answer these questions for this quarter. Part 1: Answer these questions for this quarter. 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 1 5 2 18,630.00 2 Wages, tips, and other compensation. 3 1,863.00 3 Federal income tax withheld from wages, tips, and other compensation .. Check and go to line 6. 4 If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 2 5a Taxable social security wages 18,630.00 x 0.124 = 2,310.12 0 x 0.062 = 0 5a (i) Qualified sick leave wages. 0 x 0.062 = o 5a (ii) Qualified family leave wages o x 0.124 = 0 5b Taxable social security tips ... x 0.029 = 540.27 18,630.00 50 Taxable Medicare wages & tips. o x 0.009 = 0 > 5d Taxable wages & tips subject to Additional Medicare Tax withholding 5e 2,850.39 5e Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d 5f o 5f Section 3121(9) Notice and Demand-Tax due on unreported tips (see instructions) 6 4,713.39 6 Total taxes before adjustments. Add lines 3, 5e, and 5f. 7 0.61 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay 00 8 0 9 Current quarter's adjustments for tips and group-term life insurance 9 0 10 Total taxes after adjustments. Combine lines 6 through 9..... 10 4,714 X 11a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974. 11a 0 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 . 11b o 110 Nonrefundable portion of employee retention credit from Worksheet 1 11c 0 You MUST complete all three 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. 3-2021) Employer identification number (EIN) Name (not your trade name) QUALITY REPAIRS 00-0004701 Part 1: Answer these questions for this quarter. (continued) 11d Total nonrefundable credits. Add lines 11a, 11b, and 11c.. 11d o 12 Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10...... 12 4,714 13a 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. 13a 4,040.04 LIG appreu Tom TONTIT 94194, 949 (PR) 9444, or 944-4 PP meu mi me current quarter 13b Reserved for the future use. 13b 0 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 13c o 13d Refundable portion of employee retention credit from Worksheet 1 . 13d o 13e Total deposits and refundable credits. Add lines 13a, 13c, and 13d 13e 4,040.04 X 13f Total advances received from filing Form(s) 7200 for the quarter 13f 0 13g Total deposits and refundable credits less advances. Subtract line 13f from line 13e 13g 4,040.04 X 14 Balance due. If line 12 is more than line 13g, enter the difference and see instructions. 14 673.96 o 15 Overpayment. If line 13g is more than line 12, enter the difference Check one: Apply to next return. Send a refund. Part 2: Tell us about your deposit schedule and tax liability for this quarter. If you're unsure about whether you're a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. 16 Check one: C X a. Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you're a monthly schedule depositor, complete the deposit schedule below; if you're 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 1,346.68 Tax liability: Month 1 1,346.68 Month 2 1,346.68 X Month 3 1,346.68 Total liability for quarter 4,040.04 X Total must equal line 12. 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. Go to Part 3. You MUST complete all three pages of Form 941 and SIGN it. Next Page 2 Form 941 (Rev. 3-2021) Employer identification number (EIN) Name (not your trade name) QUALITY REPAIRS 00-0004701 Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. Check here, and 17 If your business has closed or you stopped paying wages enter the final date you paid wages 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 Qualified health plan expenses allocable to qualified sick leave wages. 19 0 20 Qualified health plan expenses allocable to qualified family leave wages. 20 0 21 Qualified wages for the employee retention credit 21 0 Quameu wages Toi ue empioyee retention credit........ 21 22 Qualified health plan expenses allocable to wages reported on line 21 22 o 23 Credit from Form 5884-C, line 11, for this quarter 23 0 24. Reserved for the future use. 24 o 25 0 25 Reserved for the future use. 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. No 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 all three 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. Print your Student name here X Sign your name here Student Print your President title here Date 1/31/-- Best daytime phone 501-555-7331 Paid Preparer Use Only Check if you are self-emploved ... 1 Preparer's name PTIN Preparer's signature Date Firm's name (or yours if self-employed) EIN Address Phone City State ZIP code Page 3 Form 941 (Rev. 3-2021) Source: Internal Revenue Service c. Employer's Report of State Income Tax Withheld for the quarter, due on or before January 31, 20--. EMPLOYER'S REPORT OF STATE INCOME TAX WITHHELD (DO NOT WRITE IN THIS SPACE) WITHHOLDING IDENTIFICATION MONTH OF OR IMPORTANT: PLEASE REFER NUMBER TO THIS NUMBER IN ANY QUARTER ENDING CORRESPONDENCE - 00-0-3301 DEC. 20-- 1. GROSS PAYROLL 18,630 THIS PERIOD STATE INCOME TAY LEI NONIEWOLKLO NUUS MIL ILENI 18,630 THIS PERIOD 2. STATE INCOME TAX 1,304.10 IF YOU ARE A SEASONAL WITHHELD EMPLOYER AND THIS IS YOUR FINAL REPORT FOR THIS SEASON, QUALITY REPAIRS 10 SUMMIT SQUARE CITY, STATE 00000-0000 3. ADJUSTMENT FOR CHECK HERE AND SHOW THE NEXT MONTH PREVIOUS 0 IN WHICH YOU WILL PAY WAGES PERIOD(S). (ATTACH STATEMENT) 4. TOTAL ADJUSTED TAX (LINE 2 PLUS OR MINUS LINE 3) 16,767 X IF NAME OR ADDRESS IS INCORRECT, PLEASE MAKE CORRECTIONS. 5. PENALTY (35% OF LINE 4) 0 THIS REPORT MUST BE RETURNED EVEN IF NO AMOUNT HAS BEEN WITHHELD 6. INTEREST 0 7. TOTAL AMOUNT DUE AND PAYABLE $ Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this return, including any accompanying schedules and statements, is true and complete. If prepared by a person other than taxpayer, his affirmation is based on all information of which he has any knowledge. 18,071.10 X MAIL THIS REPORT WITH CHECK OR MONEY ORDER PAYABLE TO THE DEPT. OF REVENUE ON OR BEFORE DUE SIGNATURF: STUDENT TITLE: President DATE: 1/31/20-- NATE TO AVOIN DERIAI TV Figure 3.8 During the fourth quarter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. Using the forms supplied below, complete the following forms for the fourth quarter. If an amount or input box does not require an entry, leave it blank or enter "O". Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $18,630.00 $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For this edition, the 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been used. a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET - Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 Type of Tax (Form) 941 Tax Period 4th quarter Figure 3.8 During the fourth quarter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. U- below, complete the following forms for the fourth quarter. If an amount or input box does not require an entry, leave it blank or enter "O". Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $18,630.00 $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 941 Tax Period Type of Tax (Form) 4th quarter erter of 20--, there were seven biweekly paydays on Friday (October 4, 18; November 1, 15, 29; December 13, 27) for Quality Repairs. Using the forms supplied Following forms for the fourth quarter. ut box does not require an entry, leave it blank or enter "0". Quarterly Payroll Data OASDI HI FIT SIT $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 270.14 each pay 673.34 e federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For this edition, the Eax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been used. Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET 00-0004701 Name QUALITY REPAIRS 12 Amount of Deposit 1,346.68 941 Tax Period 4th quarter Quarterly Payroll Data Total Earnings 5 Employees OASDI HI FIT SIT $1,155.06 $270.14 $1,863.00 $1,304.10 $1,155.06 $18,630.00 Employer's OASDI Employer's HI Federal deposit liability each pay 270.14 673.34 As we go to press, the federal income tax rates for 2022 are being determined by budget talks in Washington and not available for publication. For 2021 federal income tax tables for Manual Systems with Forms W-4 from 2020 or Later with Standard Withholding and 2021 FICA rates have been a. Complete the Federal Deposit Information Worksheets reflecting electronic deposits (monthly depositor). Federal deposit liability each pay, $673.34. FEDERAL DEPOSIT INFORMATION WORKSHEET Employer 00-0004701 Name Identification Number QUALITY REPAIRS 12 Amount of Deposit 1,346.68 Month Tax Year Ends 941 Tax Period 4th quarter Type of Tax (Form) 10 SUMMIT SQUARE Phone Number Address (501) 555-7331 City, State, ZIP CITY, STATE 00000-0000 To be deposited on or before November 15, 20-- FEDERAL DEPOSIT INFORMATION WORKSHEET FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 X Type of Tax (Form) 941 Tax Period 4th quarter Address 10 SUMMIT SQUARE Phone Number (501) 555-7331 City, State, ZIP CITY, STATE 00000-0000 To be deposited on or before December 15, 20-- FEDERAL DEPOSIT INFORMATION WORKSHEET Employer Identification Number 00-0004701 Name QUALITY REPAIRS Month Tax Year Ends 12 Amount of Deposit 1,346.68 Type of Tax (Form) 941 Tax Period 4th quarter Address 10 SUMMIT SQUARE Phone Number (501) 555-7331 City, State, ZIP CITY, STATE 00000-000 To be deposited on or before January 15, 20-- b. Employer's Quarterly Federal Tax Return, Form 941. The form is signed by you as president on January 31, 20--, Hint: Line 7 instructions. Fill in Form 941 through line 6, and then fill in Part 2, line 16 or Schedule B. Take that information and fill in line 10. Lines 6 and 10 must equa amounts are not the same, correct by entering amount to make equal on line 7. Line 7 differences are caused by how calculations are made on Form 941 and the amounts from employee's earning plus the employer's payroll tax amounts each pay. Form 941 for 20-- Employer's QUARTERLY Federal Tax Return (Rev. March 2021) Department of the Treasury - Internal Revenue Service OMB No. 1545-0029 Employer identification number (EIN) 0 0 0 0 0 4 7 o 1 Name (not your trade name) QUALITY REPAIRS Report for this Quarter of 20-- (Select one.) October, November, December Go to www.irs.gov/Form 941 for instructions and the latest information. Trade name (if any) Address 10 SUMMIT SQUARE Number Street Suite or room number CITY ST 00000-0000 City State ZIP code Foreign country name Foreign province/county Foreign postal code Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1; Answer these questions for this quarter. Part 1: Answer these questions for this quarter. 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 1 5 2 18,630.00 2 Wages, tips, and other compensation. 3 1,863.00 3 Federal income tax withheld from wages, tips, and other compensation .. Check and go to line 6. 4 If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 2 5a Taxable social security wages 18,630.00 x 0.124 = 2,310.12 0 x 0.062 = 0 5a (i) Qualified sick leave wages. 0 x 0.062 = o 5a (ii) Qualified family leave wages o x 0.124 = 0 5b Taxable social security tips ... x 0.029 = 540.27 18,630.00 50 Taxable Medicare wages & tips. o x 0.009 = 0 > 5d Taxable wages & tips subject to Additional Medicare Tax withholding 5e 2,850.39 5e Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d 5f o 5f Section 3121(9) Notice and Demand-Tax due on unreported tips (see instructions) 6 4,713.39 6 Total taxes before adjustments. Add lines 3, 5e, and 5f. 7 0.61 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay 00 8 0 9 Current quarter's adjustments for tips and group-term life insurance 9 0 10 Total taxes after adjustments. Combine lines 6 through 9..... 10 4,714 X 11a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974. 11a 0 11b Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1 . 11b o 110 Nonrefundable portion of employee retention credit from Worksheet 1 11c 0 You MUST complete all three 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. 3-2021) Employer identification number (EIN) Name (not your trade name) QUALITY REPAIRS 00-0004701 Part 1: Answer these questions for this quarter. (continued) 11d Total nonrefundable credits. Add lines 11a, 11b, and 11c.. 11d o 12 Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10...... 12 4,714 13a 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. 13a 4,040.04 LIG appreu Tom TONTIT 94194, 949 (PR) 9444, or 944-4 PP meu mi me current quarter 13b Reserved for the future use. 13b 0 13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1 13c o 13d Refundable portion of employee retention credit from Worksheet 1 . 13d o 13e Total deposits and refundable credits. Add lines 13a, 13c, and 13d 13e 4,040.04 X 13f Total advances received from filing Form(s) 7200 for the quarter 13f 0 13g Total deposits and refundable credits less advances. Subtract line 13f from line 13e 13g 4,040.04 X 14 Balance due. If line 12 is more than line 13g, enter the difference and see instructions. 14 673.96 o 15 Overpayment. If line 13g is more than line 12, enter the difference Check one: Apply to next return. Send a refund. Part 2: Tell us about your deposit schedule and tax liability for this quarter. If you're unsure about whether you're a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. 16 Check one: C X a. Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you're a monthly schedule depositor, complete the deposit schedule below; if you're 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 1,346.68 Tax liability: Month 1 1,346.68 Month 2 1,346.68 X Month 3 1,346.68 Total liability for quarter 4,040.04 X Total must equal line 12. 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. Go to Part 3. You MUST complete all three pages of Form 941 and SIGN it. Next Page 2 Form 941 (Rev. 3-2021) Employer identification number (EIN) Name (not your trade name) QUALITY REPAIRS 00-0004701 Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. Check here, and 17 If your business has closed or you stopped paying wages enter the final date you paid wages 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 Qualified health plan expenses allocable to qualified sick leave wages. 19 0 20 Qualified health plan expenses allocable to qualified family leave wages. 20 0 21 Qualified wages for the employee retention credit 21 0 Quameu wages Toi ue empioyee retention credit........ 21 22 Qualified health plan expenses allocable to wages reported on line 21 22 o 23 Credit from Form 5884-C, line 11, for this quarter 23 0 24. Reserved for the future use. 24 o 25 0 25 Reserved for the future use. 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. No 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 all three 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. Print your Student name here X Sign your name here Student Print your President title here Date 1/31/-- Best daytime phone 501-555-7331 Paid Preparer Use Only Check if you are self-emploved ... 1 Preparer's name PTIN Preparer's signature Date Firm's name (or yours if self-employed) EIN Address Phone City State ZIP code Page 3 Form 941 (Rev. 3-2021) Source: Internal Revenue Service c. Employer's Report of State Income Tax Withheld for the quarter, due on or before January 31, 20--. EMPLOYER'S REPORT OF STATE INCOME TAX WITHHELD (DO NOT WRITE IN THIS SPACE) WITHHOLDING IDENTIFICATION MONTH OF OR IMPORTANT: PLEASE REFER NUMBER TO THIS NUMBER IN ANY QUARTER ENDING CORRESPONDENCE - 00-0-3301 DEC. 20-- 1. GROSS PAYROLL 18,630 THIS PERIOD STATE INCOME TAY LEI NONIEWOLKLO NUUS MIL ILENI 18,630 THIS PERIOD 2. STATE INCOME TAX 1,304.10 IF YOU ARE A SEASONAL WITHHELD EMPLOYER AND THIS IS YOUR FINAL REPORT FOR THIS SEASON, QUALITY REPAIRS 10 SUMMIT SQUARE CITY, STATE 00000-0000 3. ADJUSTMENT FOR CHECK HERE AND SHOW THE NEXT MONTH PREVIOUS 0 IN WHICH YOU WILL PAY WAGES PERIOD(S). (ATTACH STATEMENT) 4. TOTAL ADJUSTED TAX (LINE 2 PLUS OR MINUS LINE 3) 16,767 X IF NAME OR ADDRESS IS INCORRECT, PLEASE MAKE CORRECTIONS. 5. PENALTY (35% OF LINE 4) 0 THIS REPORT MUST BE RETURNED EVEN IF NO AMOUNT HAS BEEN WITHHELD 6. INTEREST 0 7. TOTAL AMOUNT DUE AND PAYABLE $ Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this return, including any accompanying schedules and statements, is true and complete. If prepared by a person other than taxpayer, his affirmation is based on all information of which he has any knowledge. 18,071.10 X MAIL THIS REPORT WITH CHECK OR MONEY ORDER PAYABLE TO THE DEPT. OF REVENUE ON OR BEFORE DUE SIGNATURF: STUDENT TITLE: President DATE: 1/31/20-- NATE TO AVOIN DERIAI TV