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MAINE REVENUE SERVICES FORM 941A-ME AMENDED RETURN OF MAINE INCOME TAX WITHHOLDING Period Covered MM DD 1306320 to YYYY Withholding originally reported for the quarter. I certify that payee statements Forms W-2/W-2C or original/corrected 1099 statements have been issued to employee s or payee s included on Schedule 2A of Form 941A-ME and I am enclosing copies of these forms to verify my refund request. O. BOX 1065 AUGUSTA ME 04332-1065 If not enc.

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