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EMPLOYER DATA (enter this data as you would like to see it on the reconciliation)

Employer name:

EIN:

Tax year:
on the reconciliation)
Agency Name: 0 EIN: 0

Tax Year: PAYROLL YEAR-END FORMS 941/941-X and W-2/W-2c BALANCING


FORM 941 LINE # 2 3 5A 5A 5C 5C 7A 9 10 11
EXCLUDE BALANCE DUE
GROSS INCOME OASI OASI MEDICARE MEDICARE EARNED NET DEPOSITS FOR OR
QUARTER * SUBJ W/H TAX W/H WAGES TAX WAGES TAX FRACTIONS INC CR TAXES DEPOSITS PREVIOUS YR (REFUND)
1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Forms 941-X (Auto-fill from row 37 below) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
941 TOTALS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

BOX 1 BOX 2 BOX 3 BOX 4 BOX 5 BOX 6 FRACTIONS BOX 9


HRMS W-3 Report Totals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (Includes ER Share Below)
EMPLOYER SHARE 0.00 0.00
ROUNDING/ADJ'S 0.00 0.00 0.00
W-2c Totals (Auto-fill from row 59 below ) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (Includes ER Share Below)
Employer Share of Manual Adj 0.00 0.00
Adjusted HRMS Form 6559 Report Totals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

DIFFERENCE: 6559 to W-3 (941 for EIC) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
DIFFERENCE MUST EQUAL ZERO
NOTE: EXPLAIN DIFFERENCES

FORMS 941-X - Current Year

GROSS INCOME OASI OASI MEDICARE MEDICARE EARNED NET


QUARTER * SUBJ W/H TAX W/H WAGES TAX WAGES TAX FRACTIONS INC CR TAXES
1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
941-X TOTALS (Auto-fills row 13 above) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

COMMENTS:

Enter Forms W-2c amounts for year


being corrected. Example: If the W-2c
was for 2008, enter in 2008.

W-2c Detail - Current Year GROSS INCOME OASI OASI MEDICARE MEDICARE EARNED
Employee Name SUBJ W/H TAX W/H WAGES TAX WAGES TAX FRACTIONS INC CR
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
W-2c Totals (Auto-fills rows 20 and 30 above) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

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