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3 Check and go to line 6. x 0.124 x 0.02 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) ept. 12 (Quarter 3), or Dec. 12 (Quarter 4) Wages, tips, and other compensation Federal income tax withheld from wages, tips, and other compensation If no wages, tips, and other compensation are subject to social security of Medicare tax Column 1 Column 2 Taxable social security wages 0.00 b Taxable social security tips K 0.124 0.00 Taxable Medicare wages & tips 0.00 a Taxable wages & tips subject to Additional Medicare Tax withholding 0.000 0.00 Add Column 2 from line 5, 5, 5c, and Sd Section 3121 Notice and Demand Tax due on unreported tips see instructions Total taken before adjustments Addines 3, 5, and Current quarters adjustment for fractions of centa Current urter's adjustment for sick bay Current quarter's adjustments for tips and group-term life insurance Totalttes after adjustments Combine Ines 6 through 1 Qualified small business payroll tax credit for increasing research activities Attach Form 1974 2 Total taxes after adjustments and credits. Subtract 11 from line 10 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 141, 141(PR), 044-X. 944X Por 944-X (5Pis the current quarter 4 tance dus ir mothanine 13, enter the difference and we aructions Overpayment line 13 is more than in 12. the ofference 0.00 Check one You MUST complete both pages of Form 541 and BAGNI 0.0 5e 51 6 7 0.0 B 9 10 0.0 11 12 0.0 13 14 Apply next return 00 0.0 Send a refund Next

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