EIN 	Name Control	Business Name 1	Business Name 2	Address 1	Address 2	City	State	Zip Code	Agent Name	Agent Title	Contact Name	Contact Title	Phone Number	e-Mail Address	Signature Name	Signature Date	Account Type	Routing Number	Account Number	PIN ( Indirect Filers)	Year of Return	Single State Filer	Is ANY your FUTA tax excluded from State Unemployment Tax?	Is ALL of your FUTA tax excluded from State unemployment Tax?	Final Return	No Payments	Total Payments	State Contributions Paid on Time (All States)	State Contributions Paid Late (All States)	Payments Exempt from FUTA Tax	Fringe Benefits	Group Term Life Insurance	Retirement/Pension	Dependent Care	Other	Refund or Apply Overpayment	"Payments for Services ($7,000 or Higher)"	Tax Deposits 	Quarter 1 Liability	Quarter 2 Liability	Quarter 3 Liability	Quarter 4 Liability	State Abbreviation 1	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 2	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 3	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 4	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 5	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 6	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 7	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 8	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 9	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 10	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 11	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 12	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 13	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 14	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 15	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 16	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 17	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 18	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 19	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 20	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 21	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 22	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 23	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 24	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 25	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 26	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 27	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 28	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 29	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 30	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 31	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 32	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 33	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 34	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 35	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 36	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 36	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 37	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 38	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 39	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 40	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 41	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 42	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 43	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 44	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 45	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 46	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 47	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 48	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 49	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 	State Abbreviation 50	State Credit Reduction Wages	State Taxable Payroll	 Experience Rate 
666666666	ELEC	Electric Corporation	Test International	242 Elm St.	Suite Z	Annapolis Junction	MD	20701	Tim Welch	Accountant	Tina Welch	Bookeeper	3015551212	tw@lswonline.com	Tim Welsh	4/1/2004					2009	N	N	N	N	N	"$25,000.00 "	$500.00 	$250.00 	$100.00 			Y			R	$200.00 	$500.00 	$125.00 	$125.00 	$125.00 	$131.40 	MI	"$25,000.00 "	"$25,000.00 "	0.003		 	 	   																																																																																																																																																																																																								
777777777	TEST	Testing Corporation	Storage Solutions	223 Misdemeanor Ave	Suite B	Rockville	MD	20654	Kenneth Sims	President	Brenda Willis	Financial Secretary	2402224544	bw@lswonline.com	Brenda Willis	3/1/2004	Checking	255071981	333333333		2009	N	N	N	Y	N	"$10,000.00 "	$300.00 	$100.00 	$0.00 	Y	Y				R	$200.00 	$600.00 	$50.00 	$50.00 	$50.00 	$47.60 	CA				AZ																																																																																																																																																																																																											
555555555	JOHN	Johnson Plumbing	Roto Rooter	21 History Road		Springdale	MD	20774	James Johnson	Owner	Jenny Wilson	Bookeeper	3013244929	jj@lswonline.com	James Johnson	3/15/2004					2009	Y	N	Y	N	N	"$1,000.00 "	$0.00 	$0.00 	$230.00 				Y		R	$400.00 	$30.00 	$6.00 	$6.00 	$6.00 	$4.94 	TX								 	  																																																																																																																																																																																																						
888888888	HENN	Henning Systems		393 Florida Ave		Silver Spring	MD	20601	Cynthia Henning	Owner	Sandra Bullock	Bookeeper	3018393209	sb@lswonline.com	Cynthia Henning	4/12/2004					2009	N	N	N	N	N	"$50,000.00 "	"$2,000.00 "	$250.00 	$0.00 						A	"$1,000.00 "	"$3,500.00 "	$203.00 	$203.00 	$203.00 	$204.00 	AL				GA