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941x Form 2015
June
City
ZIP code
State
3: July, August, September
4: October, November, December
Foreign country name
Foreign province/county
Foreign postal code
Read the separate instructions before completing this form. Use this form to correct
errors you made on Form 941 or 941-SS. Use a separate Form 941-X for each quarter
that needs correction. Type or print within the boxes. You MUST complete all three
pages. Do not attach this form to Form 941 or 941-SS.
Part 1: Select ONLY one process. See...
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