Lidge Company of Texas (TX) pays its employees monthly. The following payroll information is for the second quarter of the year.

WITHHOLDINGS EMPLOYER'S

Wages OASDI HI FIT OASDI HI

April $ 86,100 $ 3,616.20 $1,248.46 $ 9,650 $ 5,338.20 $1,248.45

May 92,500 3,885.00 1,341.26 10,005 5,735.00 1,341.25

June 73,400 3,082.80 1,064.30 8,995 4,550.80 1,064.30

Totals $252,000 $10,584.00 $3,654.02 $28,650 $15,624.00 $3,654.00

The number of employees on March 12 was 11.

Complete the following portion of Form 941 from the information presented in Problem 12.