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Case File
efta-efta01219703DOJ Data Set 9OtherName (as shoun on page I
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01219703
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Name (as shoun on page I
Semi-Weekly Deposit Schedule
A. First Month of Quarter (Days of the Month)
_t O
3 O
_CO
_LO
6 Et
13 O
20
27 0
Month 1 Liability: Enter total here and on Pan 2, line 81
Chad( a box only If you
had a next-banking day
withholding obligation.
B. Second Month of Quarter (Days of the Month)
1 O
B O
15 O
22 O
29 O
2 O
9 O
16 O
23 O
30 O
3 O
10 O
17 O
24 O
31 O
4 O
ii O
18 O
25 O
Check a box only if you
had a next-banking day
withholding obligation.
5 O
12 O
19 O
26 O
6 O
13 O
20 O
27 O
7 O
14 O
21 O
28 O
Month 2 Liability: Enter total here and on Part 2, line 82
$
C. Third Month of Quarter (Days of the Month)
1 O
8 O
15 O
22 El
29 O
2 O
9 O
16 O
23 O
30 O
3 O
10 O
17 O
24 O
31 O
4 O
ii O
18 O
25 O
Check a box only if you
had a next-banking day
withholding obligation.
5 O
12 O
19 O
26 O
6 O
13 O
20 O
27 O
7 O
14 O
21 O
28 O
Month 3 Liability: Enter total here and on Part 2, line 83
$
Part 5
Amended Form Al-QRT Return Information
If you checked the box "Amended Return' in Part 1. explain why an amended Form Al-ORT is being filed (include additional sheets, if necessary):
Part 6
Final Form AI-QRT
If you checked the box "Final Return' in Pan 1. check the box that indicates why this is a final return:
1 K Reorganization or change in business entity (example: from corporation to partnership).
2 0 Business sold.
3 0 Business stopped paying wages and will not have any employees in the future.
4 0 Business permanently closed.
5 0 Business has only leased or temporary agency employees.
6 0 Other (specify reason):
7 K Check this box if records will be kept at a location different from the address shown in Part 1.
Name:
Number and Street:
City:
State:
ZIP Code:
8 K Check this box if there is a successor employer.
Name:
EIN: ,
Number and Street:
City:
State:
ZIP Code:
ADOR 10888 (17)
AZ Form AVORT (2017)
Page 2 of 2
EFTA01219703
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