Form FR-900Q 2013 Employer/Payor

2013 FR 900Q *139000710002* 04202013 2013 FR 900Q Employer/Payor Account Number Adjustment to a previous quarter of this year Fill in circle if a minus Business mailing address 1 Business mailing address 2 Business name City State Zip Code + 4 DC income tax withheld this quarter per W2 s/1099 s DCW006Q Declaration of paid preparer is based on the information available to the preparer District of Columbia Due Date: Fill in Fill in Government of the if FEIN if final return if non wage if SSN Tax Due Tax Period Ending (MMYY) OFFICIAL USE ONLY Taxpayer Identification Number Fill in Taxpayer s signature Title Date Paid Preparer s Signature Date Telephone number of person to contact This is a FILL IN format Please do not handwrite any data on this form other than your signature Under penalties of law I declare that to the best of my knowledge this return is correct Preparer s PTIN Vendor ID#0002 Withholding Tax Quarterly Return