During the third calendar quarter of 20--, the Beechtree Inn, owned by Dawn Smedley, employed the persons listed below. Also given are the employees' salaries or wages and the amount of tips reported to the owner. The tips were reported by the 10th of each month. The federal income tax and FICA tax to be withheld from the tips were estimated by the owner and withheld equally over the 13 weekly pay periods. The employer's portion of FICA tax on the tips was estimated as the same amount.

Employees are paid weekly on Friday. The following paydays occurred during this quarter:
July AugustSeptember
5 weekly paydays 4 weekly paydays 4 weekly paydays
Taxes withheld for the 13 paydays in the third quarter follow:

Based on the information given, complete Form 941 on the following pages for Dawn Smedley.
Phone number: (901)555-7959

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Quarter's Quarter's Quarter'sQuarte's Tips S577.50 199.38 $1,980.00 1 Grant Frazier Joseph LaVanga Howard Cohen 3,120.00 3,240.90 3,493.10 3,640.30 3,704.00 6 Helen Woods 1 1 0 $64,875.00 $14,078.30 $3,316.04 $1,144.78 $8,216.00 Employees Federal Income Tax Weekly FICA Taxes Withheld on Wages Weekly FICA Taxes on Tips OASDI HI OASDI HI $15.70 15.70 $632 per week Employees' $209.59 Employer's 309.40 $72.36 72.36 Employees' $45.48 Employer's 67.14