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 (YYYY)	Total Wages (Currency)	Total Tax Withheld (Currency)	"Wages not Subject to SS/Medicare (Valid Values 1 for Yes, 0 for No)"	Taxable SS Wages (Currency)	Taxable SS Tips (Currency)	Taxable Medicare Wages (Currency)	Not Used	Not Used	Current Year's Adjustment (Currency)	COBRA Premium Assistance Payments (Currency)	Number of Individuals provided COBRA Premium Assistance (Positive Integer)	Not Used	Not Used	Not Used	Total Deposits (Currency)	Deposit State (Two Character Abbreviation)	Date of Final Return (MM/DD/YYYY)	Refund or Apply to Next Return ( for Overpayment Only ) (R for Refund - A for Apply)	January Liability (Currency)	February Liability (Currency)	March Liability (Currency)	April Liability (Currency)	May Liability (Currency)	June Liability (Currency)	July Liability (Currency)	August Liability (Currency)	September Liability (Currency)	October Liability (Currency)	November Liability (Currency)	December Liability (Currency)
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						2011	"$1,000.00 "	"$1,000.00 "	0	"$1,000.00 "	"$1,000.00 "	"$1,000.00 "	1	$200.00 	$0.00 	$10.00 	1	0			$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						2011	"$10,000.00 "	"$10,000.00 "	0	"$10,000.00 "	"$10,000.00 "	"$10,000.00 "	0	$0.00 	$0.00 	$20.00 	2	0			"$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						2011	"$50,000.00 "	"$50,000.00 "	1	"$5,000.00 "	"$5,000.00 "	"$5,000.00 "	0	$0.00 	$0.00 	$30.00 	3	0			"$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			2011	"$100,000.00 "	"$25,000.00 "	0	"$100,000.00 "	"$100,000.00 "	"$100,000.00 "	0	$0.00 	$0.00 	$0.00 	1	250	"$7,500.00 "		"$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 "	"$4,620.87 "