Form 941me Loose - Employer'S Return Of Maine Income Tax Withholding

MAINE REVENUE SERVICES

FORM 941ME

Loose

EMPLOYER’S RETURN

2006

*0606220*

OF MAINE INCOME TAX WITHHOLDING

QUARTER #

A. Number of payees subject to Maine income tax

Withholding Account Number:

withholding. ............................................................... A.

Period Covered:

B. Check here if MRS has granted an exception to report non-wage

withholding detail annually on magnetic media. See instructions. ................... B.

1. Maine income tax withheld for this quarter

Y Y

(from Schedule 2, line 11) ............... 1. $

Name and Address:

2. Less semiweekly payments (from

Schedule 1, line 6) ......................... 2. $

3a. Amount due with this return (if line 1

Name

minus line 2 is positive) ................ 3a. $

3b. Overpayment to be refunded (if line 1

Street Address

minus line 2 is negative) ............... 3b. $

City

State

ZIP Code

Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.

Date ___________ Signature ___________________________ Title _______________________________ Telephone _____________________

Contact person e-mail __________________________________ Paid preparer EIN:

Maine Payroll Processor License Number:

Make check payable to:

Treasurer, State of Maine

Mail return and check to:

Maine Revenue Services, P.O. Box 1061, Augusta, ME 04332-1061

For the Third Quarter Only: please check if applicable:

I file my return electronically or my return is prepared by a tax preparer and I do not need Maine tax forms mailed to me next year.

Cancellation Notice

4. Check here and complete this section if your business is discontinued or the requirement to withhold permanently ceases. .......................

Reason for cancellation: ________________________________________________________________________________________________

________________________________________________________________________________________________

Business sold to: ________________________________________________________

Last Payroll Date:

M M

Address: ________________________________________________________

________________________________________________________

Date Sold:

M M

Telephone: ________________________________________________________

Note: Use the Name and Address Change Form (Form 941/C1C-ME) to change your business

name or address. This form is available on-line at (click “Forms,

Publications & Applications” link, then select “Employment Taxes”).

Office

use only

Form 941me Loose - Employer'S Return Of Maine Income Tax Withholding - 2006

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