Form 941 SCH B 941 SCH B Report of Tax Liability for Semiweekly Schedule Deposito

Schedule B (Form 941):

960311

Report of Tax Liability for Semiweekly Schedule Depositors
(Rev. January 2017)

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

Employer identification number
(EIN)

Report for this Quarter...
(Check one.)

—

1: January, February, March
Name (not your trade name)

2: April, May, June

Calendar year

3: July, August, September

(Also check quarter)

4: October, November, December
Use this schedule to show your TAX LIABILITY for the quarter; don't use it to show your deposits. When you file this form with Form 941 or
Form 941-SS, don't change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must fill out this form and attach it to
Form 941 or Form 941-SS if you're 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 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

.
.
.
.
.
.
.

Tax liability for Month 1

.

.
.
.
.
.
.
.

Tax liability for Month 2

.

.
.
.
.
.
.
.

Tax liability for Month 3

.

Total liability for the quarter

Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3)

▶

Total must equal line 12 on Form 941 or Form 941-SS.

For Paperwork Reduction Act Notice, see separate instructions.

IRS.gov/form941

Cat. No. 11967Q

.
Schedule B (Form 941) (Rev. 1-2017)