960311
Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors                                                                    OMB No. 1545-0029
(Rev. January 2017)            Department of the Treasury — Internal Revenue Service
                                                                                      Report for this Quarter... 
Employer identification number —                                                      (Check one.)
(EIN)
                                                                                                           1: January, February, March
Name (not your trade name)
                                                                                                           2: April, May, June
Calendar year                                                   (Also check quarter)                       3: July, August, September
                                                                                                           4: October, November, December

Use this schedule to show your TAX LIABILITY for the quarter; don't use it to show your deposits. When you file this form with Form 941 or 
Form 941-SS, don't change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must fill out this form and attach it to 
Form 941 or Form 941-SS if you're a semiweekly schedule depositor or became one because your accumulated tax liability on any day was 
$100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in 
Pub. 15 for details.
Month 1
                                                                                                             Tax liability for Month 1
  1                 .     9      . 17                          . 25                  .
  2                 .     10     . 18                          . 26                  .
                                                                                                                                            .
  3                 .     11     . 19                          . 27                  .
  4                 .     12     . 20                          . 28                  .
  5                 .     13     . 21                          . 29                  .
  6                 .     14     . 22                          . 30                  .
  7                 .     15     . 23                          . 31                  .
  8                 .     16     . 24                          .
Month 2
                                                                                                             Tax liability for Month 2
  1                 .     9      . 17                          . 25                  .
  2                 .     10     . 18                          . 26                  .
                                                                                                                                            .
  3                 .     11     . 19                          . 27                  .
  4                 .     12     . 20                          . 28                  .
  5                 .     13     . 21                          . 29                  .
  6                 .     14     . 22                          . 30                  .
  7                 .     15     . 23                          . 31                  .
  8                 .     16     . 24                          .
Month 3
                                                                                                             Tax liability for Month 3
  1                 .     9      . 17                          . 25                  .
  2                 .     10     . 18                          . 26                  .
                                                                                                                                            .
  3                 .     11     . 19                          . 27                  .
  4                 .     12     . 20                          . 28                  .
  5                 .     13     . 21                          . 29                  .
  6                 .     14     . 22                          . 30                  .
  7                 .     15     . 23                          . 31                  .
  8                 .     16     . 24                          .
                                                                                                             Total liability for the quarter
                               Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3) ▶
                                   Total must equal line 12 on Form 941 or Form 941-SS.                                                     .
For Paperwork Reduction Act Notice, see separate instructions. IRS.gov/form941       Cat. No. 11967Q         Schedule B (Form 941) (Rev. 1-2017)