Figure $3\mathrm{.}811$c Reserved for future use

You MUST complete all three pages of Form $941$ and SIGN it$.$

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. $11$c Reserved for future use

You MUST complete all three pages of Form $941$ and SIGN it$.$

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. 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 $4)..........1$

$2$ Wages, tips, and other compensation $...................................2$

$3$ Federal income tax withheld from wages, tips, and other compensation $...............3.$

$4$ If no wages, tips, and other compensation are subject to social security or Medicare tax

Check and go to line $6.$

Column $2$

$5$a Taxable social security wages

Column $1$

Sa $($i$)$ Qualified sick leave wages $.$

$x0\mathrm{.}124=$

$5$a $($ii$)$ Qualified family leave wages

$0\mathrm{.}062=$

$0\mathrm{.}062=$

$5$b Taxable social security tips.

$x0\mathrm{.}124=$

$5$c Taxable Medicare wages & tips $..........$

$x0\mathrm{.}029=$

$5$d Taxable wages & tips subject to

$0\mathrm{.}009=$

Additional Medicare Tax withholding

$x0\mathrm{.}009=$

$5$e Total social security and Medicare taxes. Add Column $2$ from lines $5$a$,5$a$(1),5a(11),5b,5c,$ and $5$ddotsdots. $5.$

$5f$ Section $3121($q$)$ Notice and Demand$-$Tax due on unreported tips $($see instructions$)$

$5f$

$6$ Total taxes before adjustments. Add lines $3,5$ e$,$ and $5.$

$6$

$7$ Current quarter's adjustment for fractions of cents $.......................7$

$8$ current quarter's adjustment for sick pay $..............................8$

$9$ Current quarter's adjustments for tips and group$-$term life insurance dotsdotsdotsdotsdotsdotsdotsdotsdots. $.....9$

$11$a qualified small business payroll tax credit for increasing research activities. Attach Form $8974.....11$a

$11$b Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before

April $1,2021.......................................................11$b $11$c Reserved for future use

You MUST complete all three pages of Form $941$ and SIGN it$.$

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. $14$ Balance due. If line $12$ is more than line $13$ g $,$ enter the difference and see instructions $..$

$14$

$15$ Overpayment. If line $13$ g is more than line $12,$ enter the difference

Check one: $$ Apply to next return. $$ Send a refund.

Page $2$

Form $941($Rev$.3-2023)$

Cruz Company has gathered the information needed to complete its Form $941$ for the quarter ended September $30,20--.$ Using the information presented below, complete Part $1$ of Form $941.$

# of employees for pay perlod that Included September $12=14$ employees

Wages pald third quarter $=$$$78,568\mathrm{.}03$

Federal income tax withheld in the third quarter $=$$$9,428\mathrm{.}16$

Taxable soclal security and Medicare wages $=$$$78,568\mathrm{.}03$

Total tax deposits for the quarter $=$$$21,449\mathrm{.}07$

taxes calculated each pay period. This difference is reported on line $7$ as a deduction or an addition as "Fractions of Cents."

calculations are made on Form $941$ and the amounts withheld from employee's earning plus the employer's payroll tax amounts each pay perlod.

Form $941$ for $20--$: Employer's QUARTERLY Federal Tax Return

$($Rev$.$ March $2023)$

OMB No$.1545-0029$

Report for this Quarter of $20--$

$($Select one.$)$

Go to

www$.$irs.gov$/$Form$941$ for

Instructions and the latest

information.