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)	PTIN	Year	Total Wages	Total Tax Withheld	Wages not Subject to SS/Medicare	Taxable SS Wages	Taxable SS Tips	Taxable Medicare Wages	Number of qualified employees paid exempt wages/tips after March 31	Exempt wages/tips paid to qualified employees after March 31	Current Year's Adjustment	COBRA Premium Assistance Payments	Number of Individuals provided COBRA Premium Assistance	Number of qualified employees paid exempt wages/tips during March 19-31	Exempt wages/tips paid to qualified employees from March 19-31	Total Deposits	Deposit State	Date of Final Return	Refund or Apply to Next Return ( for Overpayment Only )	January Liability	February Liability	March Liability	April Liability	May Liability	June Liability	July Liability	August Liability	September Liability	October Liability	November Liability	December Liability
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	4/1/2006						2010	"$1,000.00 "	"$1,000.00 "	0	"$1,000.00 "	"$1,000.00 "	"$1,000.00 "	$0.00 	$0.00 	$0.00 	$10.00 	1	$0.00 		$200.00 	MD	 	R	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 	$107.66 
888888888	HENN	Henning Systems		393 Florida Ave		Silver Spring	MD	20601	Cynthia Henning	Owner	Sandra Bullock	Bookeeper	3018393209	sb@lswonline.com	Cynthia Henning	4/12/2006						2010	"$10,000.00 "	"$10,000.00 "	0	"$10,000.00 "	"$10,000.00 "	"$10,000.00 "	$0.00 	$0.00 	$0.00 	$20.00 	2	$0.00 		"$14,000.00 "	MD	 	A	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,061.25 "	"$1,096.25 "
555555555	JOHN	Johnson Plumbing	Roto Rooter	21 History Road		Springdale	MD	20774	James Johnson	Owner	Jenny Wilson	Bookeeper	3013244929	jj@lswonline.com	James Johnson	3/15/2006						2010	"$50,000.00 "	"$50,000.00 "	1	"$5,000.00 "	"$5,000.00 "	"$5,000.00 "	$0.00 	$0.00 	$0.00 	$30.00 	3	$0.00 		"$49,000.00 "	NJ		A	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,282.75 "	"$4,274.75 "
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	3/1/2006	Checking	255071981	333333333			2010	"$100,000.00 "	"$25,000.00 "	0	"$100,000.00 "	"$100,000.00 "	"$100,000.00 "	$0.00 	$0.00 	$0.00 	$0.00 	0	$250.00 		"$54,000.00 "	AR	3/30/2009	R	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.83 "	"$4,370.87 "