Transaction No. 35
Prepare Form 941, Employer's Quarterly Federal Tax Return, with respect to wages paid during the last calendar quarter. The information needed in preparing the return should be obtained from the journal for Form 941 deposits, ledger accounts, payroll registers and employees' earnings records. Remember: Wages, tips and other compensation does not include SIMPLE contributions or payments to estates and Social Security wages are subject to the $132,900 cap.
If an input box does not require an entry, leave it blank. When required, round amounts to the nearest cent.

Form 941 for 20--:
(Rev. January 2019) Employer's QUARTERLY Federal Tax Return
Department of the Treasury — Internal Revenue Service
OMB No. 1545-0029
Employer identification number (EIN)
0 0 – 0 0 0 0 6 6 0
Name (not your trade name) GLO-BRITE PAINT COMPANY
Trade name (if any)
Address
2215 SALVADOR STREET

Number Street Suite or room number

PHILADELPHIA PA 19175-0682

City State ZIP code

Foreign country name Foreign province/county Foreign postal code

Report for this Quarter of 20--
(Select one.)
October, November, December

Go to www. irs. gov/Form941 for instructions and the latest information.
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1: Answer these questions for this quarter.
1 Number of employees who received wages, tips, or other compensation for the pay period including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4) 1
10
2 Wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
171,273.47
3 Federal income tax withheld from wages, tips, and other compensation . . . . . . . . . . . . . . . . . . . . . . . . . 3
33,178.71
4 If no wages, tips, and other compensation are subject to social security or Medicare tax ☐ Check and go to line 6.
Column 1 Column 2
5a Taxable social security wages . . . . .
173,279.06
x 0.124 =
21,486.60

5b Taxable social security tips . . . . . . . .
0
x 0.124 =
0

5c Taxable Medicare wages & tips . . . . .
181,917.47
x 0.029 =
5,275.61

5d Taxable wages & tips subject to
Additional Medicare Tax withholding
0
x 0.009 =
0

5e Add Column 2 from lines 5a, 5b, 5c, and 5d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e
26,762.21
5f Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions) . . . . . . . . . . . . . . . 5f
0
6 Total taxes before adjustments. Add lines 3, 5e, and 5f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
59,940.92
7 Current quarter's adjustment for fractions of cents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
0.15
8 Current quarter's adjustment for sick pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
0
9 Current quarter's adjustments for tips and group-term life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
0
10 Total taxes after adjustments. Combine lines 6 through 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
59,941.07
11 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11
0
12 Total taxes after adjustments and credits. Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
59,941.07
13 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter . . 13
59,941.07
14 Balance due. If line 12 is more than line 13, enter the difference and see instructions . . . . . . . . . . . . . . . 14
0
15 Overpayment. If line 13 is more than line 12, enter the difference
0
Check one: ☐ Apply to next return. ☐ Send a refund.
▶ You MUST complete both pages of Form 941 and SIGN it.
Next ➡
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 17001Z Form 941 (Rev. 1-2019)

Name (not your trade name) Employer identification number (EIN)
GLO-BRITE PAINT COMPANY 00-0000660
Part 2: Tell us about your deposit schedule and tax liability for this quarter.
If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15.
16 Check one:
b
b. You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3.

Tax liability: Month 1

Month 2

Month 3

Total liability for quarter
59,941.07
Total must equal line 12.