Maine Employer's Return of Maine Income Tax Withholding

Employer's Return of Maine Income Tax Withholding
941ME
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Form 941ME

2023

Maine Revenue Services
Employer’s Return
of Maine Income Tax Withholding

Due on or Before:

Quarter #

Quarterly Period Covered:

	

MM	DD	 YYYY
Withholding Account Number:

Address

A.	
	

MM

DD

*2106200*

2023	 -	
YYYY

MM

1.	 Total Maine income tax withheld
	
for this quarter....................... $	
2a.	 Payments made (semiweekly
	
payments from Schedule 1, line
	
5 plus, if amended, any
	
payments made with, or after
	
filing, the original return)........ $	

Name

City 	

99

State 	

DD

2023
YYYY

.

.

2b.	 If amended, overpayment on
	
original return or as previously
	adjusted................................. $	

.

2c.	 Line 2a minus line 2b............. $	

.

3a.	 Amount due with this return
	
(See instructions)..................... $	

.

3b.	 Overpayment to be refunded
	 (See instructions)........................$	

.

ZIP Code

Check here if MRS granted a waiver allowing you to exclude nonwage withholding from Schedule 2. (See instructions)...................... A.

B.	 Check here if this is an amended return.............................................. B.
C.	 Check here to close your withholding account.................................... C.

If this is an amended form received after the end of the calendar year to which it applies, check each box on line 4 that applies, include a detailed
explanation of the adjustments and attach any supporting documentation to this return.
Note: Pursuant to 36 M.R.S. § 5276, if there is an overpayment of tax required to be deducted and withheld under § 5250, a refund shall be made to the
employer only to the extent that the overpayment was not deducted and withheld by the employer.
4. By checking the box(es) below, I certify that:
The overpayment on line 3b is not attributable to income taxes withheld from employees or payees OR that portion of overpayment identified on
line 3b attributable to overcollected income tax withholding for the current calendar year has been repaid to employees and written statements
have been obtained for each employee stating that the employee has not claimed and will not claim a refund or credit of the amount of the
overcollection.
Payee statements (Forms W-2/W-2C or original/corrected 1099 statements) have been issued to employee(s) or payee(s) identified as amended
on Schedule 2, and I am enclosing copies of these forms to verify my refund request.
I am enclosing an amended Form W-3ME (Reconciliation of Maine Income Tax Withheld) to reflect changes made on this form.
	 Explanation of adjustments:

Under penalties of perjury, I certify that the information contained on this return, report and attachment(s) is true and correct.
Signature:	Date:
Print Name:	

Telephone:	

Contact Person Email:

For Paid Preparers Only
Paid Preparer’s Signature:	

Date:		

Telephone:

Firm’s Name (or yours, if self-employed):		 Paid Preparer EIN:
Address:	

Maine Payroll Processor License Number
	 If enclosing a check, make check payable to:	
	
Treasurer, State of Maine	
	
and MAIL WITH RETURN TO:
	
MAINE REVENUE SERVICES	
	
P.O. BOX 1065	
	
AUGUSTA, ME 04332-1065	

If not enclosing a check
MAIL RETURN TO:
MAINE REVENUE SERVICES
P.O. BOX 1064
AUGUSTA, ME 04332-1064

Schedule 1 (Form 941ME) 2023

99

Name:

*2106204*

Withholding
Account No.:
Quarterly
Period Covered:

MM

DD

2023
YYYY

-

		

MM

DD

2023
YYYY

Schedule 1
Reconciliation of Semiweekly Payments of Income Tax Withholding

For employers or non-payroll filers required to remit withholding taxes on a semiweekly basis.
Date Wages or
Non-wages Paid

Subtotal A

Amount of
Withholding Paid

Date Wages or
Non-wages Paid

Amount of
Withholding Paid

Subtotal B

5. Total payment amount (Enter on Form 941ME, line 2)..................................................................................... $	

Date Wages or
Non-wages Paid

Amount of
Withholding Paid

Subtotal C

.

Schedule 2 (Form 941ME) 2023

99
*2106201*

Name:
Withholding
Account No.:

Quarterly Period Covered:

	2023	

MM	 DD	
YYYY	
Individual Employee/Payee Withholding Reporting and Corrections

MM	DD	

2023
YYYY

If this is an amended return, see instructions before completing this schedule.

	
A	
B	 C	D	
			
Original Return	
Amended Return	
	
Payee Name (Last, First, MI)	
Social Security Number	
Withholding	
Correct Withholding
a.	

.	.

b.	

.	.

c.	

.	.

d.	

.	.

e.	

.	.

f.	

.	.

g.	

.	.

h.	

.	.

i.	

.	.

j.	

.	.

k.	

.	.

l.	

.	.

m.	

.	.

n.	

.	.

o.	

.	.

p.	

.	.

q.	

.	.

r.	

.	.

s.	

.	.

	 6.	 Total of column C ................................................................................................................................6. $	

.

	 7.	 Total of column D ................................................................................................................................7. $	

.

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