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Fom 941 for 2017: Employer's QUARTERLY Federal Tax Return 150117 OMB No. 1545-0029 (Rev. January 2017) Department of the TreasuryInternal Revenue Service Report for this Quarter of 2017 (Check one.) Employer identification number (EIN) Name (not your trade name) Trade name ff any) Glo- Brite Piant Company 1: January, February, March 2: April, May, June 3: July, August, September x4: October, November, December Instructions and prior year forms are Address Street Numbe 2215 Salvador Street City Suite or room number 19175-0682 ZIP code PA available at www.irs.gov/form941 State Foreign country name Foreign 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 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) 2 Wages, tips, and other compensation 2 3 Federal income tax withheld from wages, tips, and other compensation . .....3 1 4If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 5a Taxable social security wages. . 5b Taxable social security tips . . 5c Taxable Medicare wages & tips. . 5d Taxable wages & tips subject to x 0.124 = x 0.124 = 0.029 x 0.009 Additional Medicare Tax withholding Add Column 2 from lines 5a, 5b, 5c, and 5d. Section 3121(q) Notice and Demand-Tax due on unreported tips (see instructions) Total taxes before adjustments. Add lines 3, 5e, and 5f . Current quarter's adjustment for fractions of cents . Current quarter's adjustment for sick pay Current quarter's adjustments for tips and group-term life insurance .......9 Total taxes after adjustments. Combine lines 6 through 9 . 10 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11 Total taxes after adjustments and credits. Subtract line 11 from line 10 12 5e 5f 6 5e 5f .. 6 7 8 9 '7 .. 8 . 10 11 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 .. . Fom 941 for 2017: Employer's QUARTERLY Federal Tax Return 150117 OMB No. 1545-0029 (Rev. January 2017) Department of the TreasuryInternal Revenue Service Report for this Quarter of 2017 (Check one.) Employer identification number (EIN) Name (not your trade name) Trade name ff any) Glo- Brite Piant Company 1: January, February, March 2: April, May, June 3: July, August, September x4: October, November, December Instructions and prior year forms are Address Street Numbe 2215 Salvador Street City Suite or room number 19175-0682 ZIP code PA available at www.irs.gov/form941 State Foreign country name Foreign 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 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) 2 Wages, tips, and other compensation 2 3 Federal income tax withheld from wages, tips, and other compensation . .....3 1 4If no wages, tips, and other compensation are subject to social security or Medicare tax Column 1 Column 5a Taxable social security wages. . 5b Taxable social security tips . . 5c Taxable Medicare wages & tips. . 5d Taxable wages & tips subject to x 0.124 = x 0.124 = 0.029 x 0.009 Additional Medicare Tax withholding Add Column 2 from lines 5a, 5b, 5c, and 5d. Section 3121(q) Notice and Demand-Tax due on unreported tips (see instructions) Total taxes before adjustments. Add lines 3, 5e, and 5f . Current quarter's adjustment for fractions of cents . Current quarter's adjustment for sick pay Current quarter's adjustments for tips and group-term life insurance .......9 Total taxes after adjustments. Combine lines 6 through 9 . 10 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11 Total taxes after adjustments and credits. Subtract line 11 from line 10 12 5e 5f 6 5e 5f .. 6 7 8 9 '7 .. 8 . 10 11 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
