EIN 	Name Control	Business Name 1	Business Name 2	Address 1	Address 2	City	State	Zip Code	Preparer / Agent Name	Preparer / Agent Title	Company Contact Name	Company Contact Title	Phone Number	e-Mail Address	Signature Name	Signature Date	Account Type	Routing Number	Account Number	Online PIN ( For Indirect Filers Only)	Preparer Tax Identification Number (PTIN)	EIN	End of Period	Employees	Total Wages	Total Tax Withheld	Wages not Subject to SS/Medicare	Taxable SS Wages	Taxable SS Tips	Taxable Medicare Wages	Tax On Unreported Tips 3121q	Number of Qualified Employees first paid exempt wages/tips this quarter	Number of Qualified Employees paid exempt wages/tips this quarter	Exempt Wages/tips 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 during March 19-31 (Only Valid for Pre-2011 Returns)	Exempt wages/tips paid to qualified employees from March 19-31 (Only Valid for Pre-2011 Returns)	Advanced EIC (Valid for Pre-2011 Returns Only)	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						777777777	6/30/2010	240	 	 	R	 	 	 		10	$15.00 	"$20,000.00 "	$3.29 	($39.00)	$0.00 	$25.00 	3	0	$0.00 	 	 	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						888888888	6/30/2010	22	"$30,393.39 "	$23.00 	0	"$30,000.00 "	"$30,000.00 "	"$30,000.00 "		2	$3.00 	"$2,345.00 "	$39.39 	($3.30)	$0.00 	$67.00 	1	0	$0.00 	$22.00 	"$10,000.00 "	MD	0	 	S				A	"$1,000.00 "														"$1,000.00 "															"$1,000.00 "		 														"$1,000.00 "								$145.39 							$347.09 		$709.22 															"$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						555555555	6/30/2010	3000	"$769,505.49 "	"$22,302.00 "	1	"$765,594.39 "	"$765,594.39 "	"$765,594.39 "		150	$185.00 	"$30,949.00 "	"$2,382.29 "	($0.39)	$0.00 	$500.00 	25	0	$0.00 	$0.00 	"$250,000.00 "	NJ	0		S				A	$0.00 	"$3,000.00 "			 					 				 			"$50,000.00 "															"$50,000.00 "					"$50,000.00 "								"$1,918.84 "							"$46,162.32 "											"$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			666666666	6/30/2010	229	"$100,290.00 "	$33.00 	0	"$100,290.00 "	"$100,290.00 "	"$100,290.00 "		0	$0.00 	$0.00 	$232.00 	$0.00 	$0.00 	$0.00 	0	2	"$2,000.00 "	$0.00 	"$15,000.00 "	CA	0	6/30/2010	M	"$10,000.00 "	"$10,000.00 "	"$8,045.33 "	R