M 941d Form

MASSACHUSETTS DEPARTMENT OF REVENUE QUARTERLY RETURN OF INCOME TAXES WITHHELD FOR EMPLOYER PAYING WEEKLY M-941D WR YOU MUST FILE THIS FORM EVEN THOUGH NO TAX MAY BE DUE. FEDERAL IDENTIFICATION NUMBER BE SURE THIS RETURN COVERS THE CORRECT PERIOD FOR QTR. ENDING 1. AMOUNT WITHHELD 2. ADJUSTMENT FOR PRIOR QTR* AMOUNT WITHHELD IF INCORRECT SEE INSTRUCTIONS* DO NOT ALTER* 3. AMOUNT DUE AFTER ADJUSTMENT IF ANY INFORMATION IS INCORRECT SEE INSTRUCTIONS* 4A. PREVIOUS PAYMENTS MADE 4B. CREDIT FROM PREVIOUS QUARTER 4C. TOTAL ADD LINE 4A AND LINE 4B Check here if this is a final return* Check here if EFT payment. 5. TOTAL TAX DUE SUBTRACT LINE 4C FROM LINE 3 6. PENALTIES AND INTEREST 7. TOTAL AMOUNT DUE ADD LINE 5 AND LINE 6 Make check payable to the Commonwealth of Mass. Return this completed form with payment. Mail to Massachusetts Department of Revenue PO Box 7034 Boston MA 02204-7034. 8. AMOUNT OVERPAID TO BE CREDITED TO NEXT PERIOD I declare under the penalties of perjury that this return including any accompanying schedules and statements has been examined by me and to the best of my knowledge and belief is a true correct and complete return* REFUNDED Signature See instructions. Explain any adjustment on reverse or it will be disallowed* Adjustment must be from immediate prior period. List all payments made for this quarter on reverse. Title NEW OWNERS DO NOT USE PREVIOUS OWNER S FORM TO FILE YOUR RETURN* ANY CHANGE IN OWNERSHIP OR ORGANIZATION REQUIRES A NEW REGISTRATION* YOU MUST FILE A NEW FORM TA-1. NOTE THE ENTIRE OVERPAYMENT AMOUNT MUST BE EITHER CREDITED OR REFUNDED. DO NOT SPLIT THE OVERPAYMENT AMOUNT BETWEEN LINE 8 AND LINE 9. LIST DATES AND AMOUNTS OF PAYMENTS MADE FOR THIS QUARTER M-941W DATE STATE REASON FOR ADJUSTMENT REQUEST AS REPORTED Date CORRECTED AMOUNT WITHHELD PRIOR PERIOD PAID REPORTED UNDER FED. AMOUNT WITHHELD 2. ADJUSTMENT FOR PRIOR QTR* AMOUNT WITHHELD IF INCORRECT SEE INSTRUCTIONS* DO NOT ALTER* 3. AMOUNT DUE AFTER ADJUSTMENT IF ANY INFORMATION IS INCORRECT SEE INSTRUCTIONS* 4A. PREVIOUS PAYMENTS MADE 4B. AMOUNT DUE AFTER ADJUSTMENT IF ANY INFORMATION IS INCORRECT SEE INSTRUCTIONS* 4A. PREVIOUS PAYMENTS MADE 4B. CREDIT FROM PREVIOUS QUARTER 4C. TOTAL ADD LINE 4A AND LINE 4B Check here if this is a final return* Check here if EFT payment. CREDIT FROM PREVIOUS QUARTER 4C. TOTAL ADD LINE 4A AND LINE 4B Check here if this is a final return* Check here if EFT payment. 5. TOTAL TAX DUE SUBTRACT LINE 4C FROM LINE 3 6. PENALTIES AND INTEREST 7. TOTAL AMOUNT DUE ADD LINE 5 AND LINE 6 Make check payable to the Commonwealth of Mass. 5. TOTAL TAX DUE SUBTRACT LINE 4C FROM LINE 3 6. PENALTIES AND INTEREST 7. TOTAL AMOUNT DUE ADD LINE 5 AND LINE 6 Make check payable to the Commonwealth of Mass. Return this completed form with payment. Mail to Massachusetts Department of Revenue PO Box 7034 Boston MA 02204-7034. Return this completed form with payment. Mail to Massachusetts Department of Revenue PO Box 7034 Boston MA 02204-7034. 8. AMOUNT OVERPAID TO BE CREDITED TO NEXT PERIOD I declare under the penalties of perjury that this return including any accompanying schedules and statements has been examined by me and to the best of my knowledge and belief is a true correct and complete return* REFUNDED Signature See instructions.