Form Schedule B (Form 9 Schedule B (Form 9 Report of Tax Liability for Semiweekly Schedule Deposito

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SCHEDULE B,FORM 941, PAGE 1 OF 2 (PAGE 2 IS BLANK)
MARGINS; TOP 1⁄2 ”, CENTER SIDES.
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PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
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DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

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Date

O.K. to print
Revised proofs
requested

990306

Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors
(Rev. January 2006)

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

(EIN)
Employer identification number

Signature

Report for this Quarter ...

—

(Check one.)

Name (not your trade name)

1: January, February, March
2: April, May, June

(Also check quarter)

Calendar year

3: July, August, September
4: October, November, December

Use this schedule to show your TAX LIABILITY for the quarter; DO NOT use it to show your deposits. You must fill out this
form and attach it to Form 941 (or Form 941-SS) if you are a semiweekly schedule depositor or became one because your
accumulated tax liability on any day was $100,000 or more. Write your daily tax liability on the numbered space that
corresponds to the date wages were paid. See Section 11 in Pub. 15 (Circular E), Employer’s Tax Guide, for details.
Month 1
1
2
3
4
5
6
7
8
Month 2
1
2
3
4
5
6
7
8
Month 3
1
2
3
4
5
6
7
8

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9
10
11
12
13
14
15
16

9
10
11
12
13
14
15
16

9
10
11
12
13
14
15
16

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17
18
19
20
21
22
23
24

17
18
19
20
21
22
23
24

17
18
19
20
21
22
23
24

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25
26
27
28
29
30
31

25
26
27
28
29
30
31

25
26
27
28
29
30
31

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Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3) = Total tax liability for the quarter 䊳
Total must equal line 10 on Form 941 (or line 8 on Form 941-SS).

For Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11967Q

Tax liability for Month 1

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Tax liability for Month 2

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Tax liability for Month 3

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Total liability for the quarter

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Schedule B (Form 941) Rev. 1-2006