Please scroll down for the form at the bottom of this page. Review the form for accuracy.

Please scroll down for the form at the bottom of this page. Review the form for accuracy. Remember to detach the form before mailing to the agency. (CUT HERE) z STATE OF RHODE ISLAND DIVISION OF TAXATION • DEPTII00 • PO BOX 9/03 • PROVIDENCE. RI 029/0.9703 I HEREBY CERTIFY THAT THIS RETURN. TOME BEST OF MY KNOWLEDGE AND BELIEF. IS A TRUE CORRECT AND COMPLETE RETURN. SIGNATURE OF OWNER. PARTNER OR AUTHORIZED AGENT TITLE DATE • ACCOUNT IDENTIFICATION NUMBER RETURN FOR QUARIERMONTHLY PERIOD ENDING WTQM TAX AMOUNT DUE AND PAID WITHHOLDING TAX RETURN • QUARTER/MONTHLY NI-QMR1 REV 11199 EFTA01219702