Form 4977 - Schedule Of Tax Liability
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1Tax period ended
Department of the Treasury- Internal Revenue Servic
e
4977
Form
Schedule of Tax Liability
(Rev. February 2002)
Name
Employer Identification Number
Number, street, and room or suite no.
Telephone number (optional)
City or town, state, and ZIP code
This form supports adjustments to:
Form 1042
Form 940
Form 1042, Withholding Tax
Section I.
Period
Tax liability for period
Tax liability for period
Tax liability for period
Line
Line
Line
Period
Period
ending
(including any taxes assumed
(including any taxes assumed
(including any taxes assumed on
No.
No.
ending
No.
ending
on Form(s) 1000)
on Form(s) 1000)
Form(s) 1000)
7
7
7
1
21
41
15
15
15
22
42
2
Jan.
May
Sept.
22
22
22
23
43
3
30
31
31
4
24
44
Jan. total
May total
Sept. total
25
45
5
7
7
7
6
26
46
15
15
15
7
27
47
Feb.
June
Oct.
22
22
22
8
28
48
30
31
28
9
29
49
10
Feb. total
June total
Oct. total
30
50
7
7
7
11
31
51
15
15
15
12
32
52
March
July
Nov.
22
22
22
13
33
53
31
31
31
34
14
54
1
Mar. total
July total
Nov. total
15
35
55
7
7
7
16
36
56
15
15
15
17
37
57
April
August
Dec
22
22
22
18
38
58
30
31
31
39
59
19
20
Apr. total
Aug. total
60
Dec. total
40
61
61 Total liability for year (add monthly total lines from above)
Form 940, Unemployment Tax
Section II.
Quarter
Liability for Quarter (Do not include state liability)
First
Second
Third
Fourth
Total
Under penalties of perjury, I declare that I have examined the above liability schedule,
and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Title
Date
4977
Form
Catalog Number 42142L
(Rev. 02-2002)
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