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7 Current quarter's adjustment for fractions of cents ......................................... 7 8 Current quarter's adjustment for sick pay ................................................ 8 9 Current quarter's adjustments for tips and group-term life insurance ........................... 9 10 Total taxes after adjustments. Combine lines 6 through 9 ...................................... 10 11 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 ....... 11 12 Total taxes after adjustments and credits. Subtract line 11 from line 10 .................. 12 13 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments 13 applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter . . 14 Balance due. If line 12 is more than line 13, enter the difference and see instructions .................... 14 15 Overpayment. If line 13 is more than line 12, enter the difference :] Check one: I: Apply to next return. l:l Send a refund. b You MUST complete both pages of Form 941 and SIGN it. E For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 170012 Form 941 (Rev. 1-2018) Name (not your trade name) Employer identication number (EIN) QUALITY REPAIRS (JO-0004701 m Tell us about your deposit schedule and tax liability for this quarter. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. 16 Check one: v 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 are a monthly schedule depositor, complete the deposit schedule below; if you are 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 :] Month 3 :l Total liability for quarter :] 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. w Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages ................................................. l:l Check here, and enter the nal date you paid wages . 18 If you are a seasonal employer and you don't have to file a return for every quarter of the year ................. l:l Check here. m 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. Yes D Designee's name and phone number No IZl Select a 5-digit Personal Identication Number (PIN) to use when talking to the IRS. l l l \\I/ m Sign here. You MUST complete both 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. Sign your name here Student Date 1/3 1 / 20 Paid Preparer Use Only Prepa rer's name Preparer's signature Firm's name (or yours if self-employed) Address City State Print your name here Print your title here Best daytime phone 501-555 7331 Student President Check if you are self-employed . . . . n PTIN Date Phone I ll ZIP code ll Page 2 IMPORTANT: PLEASE REFER TO THIS NUMBER IN ANY CORRESPONDENCE ' IF YOU ARE A SEASONAL EMPLOYER AND THIS IS YOUR FINAL REPORT FOR THIS SEASON, CHECK HERE U AND SHOW THE NEXT MONTH IN WHICH YOU WILL PAY WAGES. EMPLOYER'S REPORT OF STATE INCOME TAX WITHHELD W1THHOLDING IDENTIFICATION N U M BER c. Employer's Report of State Income Tax Withheld for the quarter, due on or before January 31, 2020. MONTH OF OR QUARTER ENDING Form 941 (Rev. 1-2018) Source: Internal Revenue Service 00-0-3301 QUALITY REPAIRS 10 SUMMIT SQUARE CITY, STATE 00000-0000 DEC. 2019 (DO NOT WRITE IN THIS SPACE) 1. GROSS PAYROLL THIS PERIOD STATE INCOME TAX WITHH ELD 3. ADJUSTMENT FOR PREVIOUS PERIOD(S). (ATI'ACH STATEMENT) 4. TOTAL ADJUSTED TAx (LINE 2 PLUS 0R MINUS LINE 3) MI IF NAME OR ADDRESS IS INCORRECT, PLEASE MAKE CORRECTIONS. THIS REPORT MUST BE RETURNED EVEN IF NO AMOUNT HAS BEEN WITHHELD 5- PENALTY (35% OF LINE 4) 6. INTEREST Under penalties prescribed by law, I hereby affirm that to the best of my knowledge and belief this return, including any 7. TOTAL AMOUNT DUE accompanying schedules and statements, is true and complete. If prepared by a person other than taxpayer, his affirmation AND PAYABLE is based on all information of which he has any knowledge. MAIL THIS REPORT WITH CHECK OR MONEY ORDER PAYABLE TO THE DEPT. OF REVENUE ON OR BEFORE DUE SIGNATURE: STUDENT TITLE: President DATE: 1/31/20 DATE TO AVOID PENALTY