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

960309

Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors
(Rev. February 2009)

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

(EIN)
Employer identification number

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. When you file this form with Form 941
(or Form 941-SS), DO NOT change your tax liability by adjustments reported on any Forms 941-X. 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

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

9
10
11
12
13
14
15
16

9
10
11
12
13
14
15
16

9
10
11
12
13
14
15
16

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

17
18
19
20
21
22
23
24

17
18
19
20
21
22
23
24

17
18
19
20
21
22
23
24

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

25
26
27
28
29
30
31

25
26
27
28
29
30
31

25
26
27
28
29
30
31

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

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

.

Tax liability for Month 2

.

Tax liability for Month 3

.

Total liability for the quarter

.
Schedule B (Form 941) Rev. 2-2009