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(CUT HERE)
z STATE OF RHODE ISLAND
DIVISION OF TAXATION • DEPTII00 • PO BOX 9/03 • PROVIDENCE. RI 029/0.9703 WITHHOLDING TAX RETURN
QUARTER/MONTHLY
•
WTQM
I HEREBY CERTIFY THAT THIS RETURN. TOME BEST OF MY KNOWLEDGE AND
BELIEF. IS A TRUE CORRECT AND COMPLETE RETURN.
SIGNATURE OF OWNER. PARTNER OR AUTHORIZED AGENT
TITLE DATE
TAX AMOUNT
ACCOUNT IDENTIFICATION NUMBER RETURN FOR QUARIERMONTHLY PERIOD DUE AND PAID
ENDING
•
NI-QMR1 REV 11199
EFTA01219702