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	Online PIN ( For Indirect Filers Only)	End of Period	Employees	Total Wages	Total Tax Withheld	Wages not Subject to SS/Medicare	Taxable SS Wages	Taxable SS Tips	Taxable Medicare Wages	Qualified Emplohyees first paid this quarter	Qualified Employees paid Exempt Wages this quarter	Exempt Wages paid to qualified employees this quarter.	Current Quarter's Fractions of Cents	Current Quarter's Sick Pay	Current Quarter's Adjustment for tips and Group-Term Life Insurance	 COBRA Premium Assistance Payments	Number of Inviduals provide COBRA Assistance payments on Line 12a	Number of qualified employees paid exempt wages/tips March 19-31	Exempt Wages/tips paid to qualified employees March 19-31	Advanced EIC	Total Deposits	Deposit State	Seasonal	Date of Final Return	Monthly or Semi-Weekly	First Month Liability	Second Month Liability	Third Month Liability	Refund or Apply to Next Return ( for Overpayment Only )	Schedule B Month 1 Day 1	Schedule B Month 1 Day 2	Schedule B Month 1 Day 3	Schedule B Month 1 Day 4	Schedule B Month 1 Day 5	Schedule B Month 1 Day 6 	Schedule B Month 1 Day 7	Schedule B Month 1 Day 8	Schedule B Month 1 Day 9	Schedule B Month 1 Day 10	Schedule B Month 1 Day 11	Schedule B Month 1 Day 12	Schedule B Month 1 Day 13	Schedule B Month 1 Day 14	Schedule B Month 1 Day 15	Schedule B Month 1 Day 16	Schedule B Month 1 Day 17	Schedule B Month 1 Day 18	Schedule B Month 1 Day 19	Schedule B Month 1 Day 20	Schedule B Month 1 Day 21	Schedule B Month 1 Day 22	Schedule B Month 1 Day 23	Schedule B Month 1 Day 24	Schedule B Month 1 Day 25	Schedule B Month 1 Day 26	Schedule B Month 1 Day 27	Schedule B Month 1 Day 28	Schedule B Month 1 Day 29	Schedule B Month 1 Day 30	Schedule B Month 1 Day 31	Schedule B Month 2 Day 1	Schedule B Month 2 Day 2	Schedule B Month 2 Day 3	Schedule B Month 2 Day 4	Schedule B Month 2 Day 5	Schedule B Month 2 Day 6 	Schedule B Month 2 Day 7	Schedule B Month 2 Day 8	Schedule B Month 2 Day 9	Schedule B Month 2 Day 10	Schedule B Month 2 Day 11	Schedule B Month 2 Day 12	Schedule B Month 2 Day 13	Schedule B Month 2 Day 14	Schedule B Month 2 Day 15	Schedule B Month 2 Day 16	Schedule B Month 2 Day 17	Schedule B Month 2 Day 18	Schedule B Month 2 Day 19	Schedule B Month 2 Day 20	Schedule B Month 2 Day 21	Schedule B Month 2 Day 22	Schedule B Month 2 Day 23	Schedule B Month 2 Day 24	Schedule B Month 2 Day 25	Schedule B Month 2 Day 26	Schedule B Month 2 Day 27	Schedule B Month 2 Day 28	Schedule B Month 2 Day 29	Schedule B Month 2 Day 30	Schedule B Month 2 Day 31	Schedule B Month 3 Day 1	Schedule B Month 3 Day 2	Schedule B Month 3 Day 3	Schedule B Month 3 Day 4	Schedule B Month 3 Day 5	Schedule B Month 3 Day 6 	Schedule B Month 3 Day 7	Schedule B Month 3 Day 8	Schedule B Month 3 Day 9	Schedule B Month 3 Day 10	Schedule B Month 3 Day 11	Schedule B Month 3 Day 12	Schedule B Month 3 Day 13	Schedule B Month 3 Day 14	Schedule B Month 3 Day 15	Schedule B Month 3 Day 16	Schedule B Month 3 Day 17	Schedule B Month 3 Day 18	Schedule B Month 3 Day 19	Schedule B Month 3 Day 20	Schedule B Month 3 Day 21	Schedule B Month 3 Day 22	Schedule B Month 3 Day 23	Schedule B Month 3 Day 24	Schedule B Month 3 Day 25	Schedule B Month 3 Day 26	Schedule B Month 3 Day 27	Schedule B Month 3 Day 28	Schedule B Month 3 Day 29	Schedule B Month 3 Day 30	Schedule B Month 3 Day 31
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	4/1/2008					9/30/2009	240	 	 	R	 	 	 				$3.29 	($39.00)	$0.00 	$25.00 	3			 	 	MD	1	 	M	"$2,500.00 "	"$2,500.00 "	$504.29 	R							 	 		 																						 																																																													
888888888	HENN	Henning Systems		393 Florida Ave		Silver Spring	MD	20601	Cynthia Henning	Owner	Sandra Bullock	Bookeeper	3018393209	sb@lswonline.com	Cynthia Henning	4/12/2008					9/30/2009	22	"$30,393.39 "	$23.00 	0	"$30,000.00 "	"$30,000.00 "	"$30,000.00 "				$39.39 	($3.30)	$0.00 	$67.00 	1			$22.00 	"$10,000.00 "	MD	0	 	S				A	"$1,000.00 "														"$1,000.00 "															"$1,000.00 "		 														"$1,000.00 "															$347.09 		"$1,000.00 "															"$2,000.00 "														"$1,000.00 "	$0.00 
555555555	JOHN	Johnson Plumbing	Roto Rooter	21 History Road		Springdale	MD	20774	James Johnson	Owner	Jenny Wilson	Bookeeper	3013244929	jj@lswonline.com	James Johnson	3/15/2008					9/30/2009	3000	"$769,505.49 "	"$22,302.00 "	1	"$765,594.39 "	"$765,594.39 "	"$765,594.39 "				"$2,382.29 "	($0.39)	$0.00 	$500.00 	25			$0.00 	"$250,000.00 "	NJ	0		S				A	$0.00 	"$3,000.00 "			 					 				 			"$50,000.00 "															"$50,000.00 "					"$50,000.00 "															"$50,000.00 "											"$3,000.00 "								"$30,753.54 "														$0.00 								
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	3/1/2008	Checking	255071981	333333333		9/30/2009	229	"$100,290.00 "	$33.00 	0	"$100,290.00 "	"$100,290.00 "	"$100,290.00 "				$232.00 	$0.00 	$0.00 					$0.00 	"$15,000.00 "		0	7/25/2009	M	"$10,000.00 "	"$10,000.00 "	"$8,045.33 "	R