Form 4977
Schedule of Tax Liability

(Rev. 2-2002)

Cat. No. 42142L

Department of the Treasury
Internal Revenue Service

In 1 File
Print page 1

CONTENTS

Section: Page

Form 4977 Schedule of Tax Liability: 1
  Section I. Form 1042, Withholding Tax: 1
  Section II. Form 940, Unemployment Tax: 1
   
This electronic edition contains the entire text of the print edition.
 
<Page 1>

Tax period ended: ----
Name: ----
Employer Identification Number: ----
Number, street, and room or suite no.: ----
Telephone number (optional): ----
City or town, state, and ZIP code: ----
This form supports adjustments to:
-- Form 1042
-- Form 940

Section I. Form 1042, Withholding Tax

1. Period ending Jan. 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
2. Period ending Jan. 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
3. Period ending Jan. 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
4. Period ending Jan. 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
5. Jan. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
6. Period ending Feb. 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
7. Period ending Feb. 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
8. Period ending Feb. 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
9. Period ending Feb. 28
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
10. Feb. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
11. Period ending March 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
12. Period ending March 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
13. Period ending March 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
14. Period ending March 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
15. Mar. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
16. Period ending April 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
17. Period ending April 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
18. Period ending April 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
19. Period ending April 30
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
20. Apr. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
21. Period ending May 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
22. Period ending May 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
23. Period ending May 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
24. Period ending May 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
25. May total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
26. Period ending June 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
27. Period ending June 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
28. Period ending June 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
29. Period ending June 30
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
30. June total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
31. Period ending July 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
32. Period ending July 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
33. Period ending July 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
34. Period ending July 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
35. July total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
36. Period ending August 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
37. Period ending August 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
38. Period ending August 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
39. Period ending August 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
40. Aug. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
41. Period ending Sept. 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
42. Period ending Sept. 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
43. Period ending Sept. 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
44. Period ending Sept. 30
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
45. Sept. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
46. Period ending Oct. 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
47. Period ending Oct. 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
48. Period ending Oct. 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
49. Period ending Oct. 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
50. Oct. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
51. Period ending Nov. 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
52. Period ending Nov. 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
53. Period ending Nov. 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
54. Period ending Nov. 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
55. Nov. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
56. Period ending Dec 7
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
57. Period ending Dec 15
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
58. Period ending Dec 22
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
59. Period ending Dec 31
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
60. Dec. total
Tax liability for period (including any taxes assumed on Form(s) 1000): ----
61. Total liability for year (add monthly total lines from above): ----

Section II. Form 940, Unemployment Tax

Quarter

First: ----
Liability for Quarter (Do not include state liability): ----
Second: ----
Liability for Quarter (Do not include state liability): ----
Third: ----
Liability for Quarter (Do not include state liability): ----
Fourth: ----
Liability for Quarter (Do not include state liability): ----
Total: ----
Liability for Quarter (Do not include state liability): ----

Under penalties of perjury, I declare that I have examined the above liability schedule, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature: ----
Title: ----
Date: ----

End of Form 4977