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Account ID
Filing Frequency
Period Ending
File By (mm/dd/yy)
Monthly
Quarterly
11/30/21
12/31/21
01/31/22
02/28/22
03/31/22
04/30/22
05/31/22
06/30/22
07/31/22
08/31/22
09/30/22
10/31/22
11/30/22
12/31/22
Legal Name, First Line
Legal Name, Second Line
Address
City
State
Zip Code
- -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Tax Withheld
Penalty
Interest
Total Due
$
.00
$
.00
$
.00
$
.00
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