Form 901es- Me - Pass-Through Entity Withholding Quarterly Payment Voucher - 2012
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4DO NOT STAPLE OR TAPE CHECK TO YOUR FORM.
DO NOT CUT OR DETACH THIS FORM.
DO NOT SEND PHOTOCOPIES OF THIS FORM.
2012
FORM 901ES- ME
MAINE REVENUE SERVICES
PASS-THROUGH ENTITY WITHHOLDING QUARTERLY PAYMENT VOUCHER
2012
VOUCHER 1
99
DUE APRIL 30, 2012
*12941P7*
.00
Federal Employer ID Number
Amount Remitted:
Name
Address
City
State
ZIP Code
Make check payable to TREASURER, STATE OF MAINE. Mail both to: Maine Revenue Services, P.O. Box 9101, Augusta, ME 04332-9101
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