[PDF] Form 941 (Schedule B) (Rev. January 2017)





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Form 941 (Schedule B) (Rev. January 2017)

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Schedule B (Form 941):

Report of Tax Liability for Semiweekly Schedule Depositors (Rev. January 2017)Department of the Treasury — Internal Revenue Service

960311

OMB No. 1545-0029

Employer identification number

(EIN) Name (not your trade name)

Calendar year(Also check quarter)

Report for this Quarter...

(Check one.) 1:

January, February, March

2:

April, May, June

3:

July, August, September

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. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.

Tax liability for Month 1

Month 2

1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

12.13.

14. 15. 16. 17. 18. 19. 20. 21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.

Tax liability for Month 2

Month 3

1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.

Tax liability for Month 3

Total must equal line 12 on Form 941 or Form 941-SS. Fill in your total liability for the quarter (Month 1 + Month 2 + Month

3)

Total liability for the quarter

For Paperwork Reduction Act Notice, see separate instructions.IRS.gov/form941Cat. No. 11967QSchedule B (Form 941) (Rev. 1-2017)

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