Form 941 and Schedule B (Form 941) for PEI STAFFING LLC, 2019 — Document 30-3

Summary

Document 30-3 in Case 1:23-cr-00210-RDB, filed March 19, 2025: pages of Form 941 (Rev. 1-2019) in the name of PEI STAFFING LLC, followed by a Schedule B (Form 941): Report of Tax Liability for Semiweekly Schedule Depositors (Rev. January 2017) for calendar year 2019. The Form 941 portion asks about the deposit schedule and tax liability for the quarter and has a Part 4 on a third-party designee, naming Lisa Huff. The Schedule B portion lists tax liability for Month 1, Month 2 and Month 3 and a line for the total liability for the quarter.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Full text

Text recognized from a scanned document; may contain errors. Page 1 of 3 is not shown because the text could not be recognized reliably.

Case 1:23-cr-00210-RDB Document 30-3 Filed 03/19/25 Page2of3

750217

Name (not youriradename) Employer identification number (EIN)
PEI STAFFING LLC 27-3294970
Tell us about your deposit schedule and tax liability for this quarter.

LB tobe are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11
ot Pub. 15.

16 Check one: L] Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't
incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but
line 12 on this return is $100,000 or more, you must provide a record of your fedral tax liability. If you are a monthly schedule
depositor, complete the deposit schedule below: if you afé a samiweekly schedule depositor, attach Schedule B (Form 941). Go to
Part 3.

(1 Youwere a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.

Tax liabillty: Month 4 L |

Month 2 [

Month 3 | |

Total liability for quarter | | Total must equal line 12.

[X] You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Fax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.

Tell us about your business. If a question does NOT apply to your business, leave it blank.

17 If your business has closed or you stopped paying wages [_] Check here, and

enter the final date you paid wages

18 If you are a seasonal employer and you don’t have to file a return for every quarter ofthe year... L_] Check here.

[Part 4: May we speak with your third-party designee?
Do you want to allow an employes, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions

ior details.
[X] Yes. Designee’s name and phone number | LISA HUFF | | 21 6-831-8900
Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS. 34010
L] No.

Sign here. You MUST complete both pages of Form 941 and SIGN it.

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on ail information of which preparer has any knowledge.

Print your :
Sign your i name here [Lisa Huff |
name here { { aT ks Jott Print your : :
title here | Fi duciary |
Date 04-15-2019] Best daytime phone | 216 831-8500 |
Paid Preparer Use Only Check if you are self-employed... L_ |
Preparer’s name | i PTIN [ |
Preparer’s signature { Date |
Firm’s name (or yours = 3
if self-employed) | | EIN | |
Address | | Phone [ |
City | State [| ZIP code i |
Page 2 Form 941 (Rev. 1-2019}

402 24-Apr-2019 10:15 204507 1122
Case 1:23-cr-00210-RDB

Document 30-3

schedule B (Form 941):

Report of Tax Liability for Semiweekly Schedule Depositors

(Rev. January 2017)

Employer identification number

Department of the Treasury -- Intemal Revenue Service

27-3294970

Name (not yourtradename) PRT STAFFING LLC

Calendar year

2019

(Also check quarter)

Filed 03/19/25

Page 3 of 3

OMB No. 1545-0029

Report for this Quarter ..,

1: January, February, March
[| 2: April, May, June
] 3: July, August, September

| 4: October, November, December

Use this schedule to show your TAX LIABILITY for the quarter; don’t use it to snow 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 Ilabillty on any day was
$100,000 or more. Write your daily tax Ilability on the numbered space that corresponds to the date wages were paid. See Section 11 In

Pub. 15 for details.
Month 1

| WL los

37632.01]| Tax liability for Month 1

152,444.50

83.40]

Tax liability for Month 2

161,374.59

sL_ Hal |o4| 118. 6 8]o9|
Month 2

aL

s| Jal

37751.

Month 3

77.97|| Tax lability for Month 3

197,595.88

4 [ 99. 97a 119. 5 Tool loel |
7| his| 37525 . 83},9| lil |

Fill in your total liability for the quarter (Month 1+ Month 2+ Month 3)
Total must equal Ine 12 on Form 941 or Form 941-SS.

Total liability for the quarter
511,414.97

For Paperwork Reduction Act Notice, see separate instructions.

IRS.gov/form941

402 24-Apr-2019 10:15 204507 1122

Schedule B (Form 941) (Rev. 1-2017)


File and source

File

gov.uscourts.mdd.538629.30.3.pdf

Size

1,964,733 bytes

SHA-256

fa2256b8d182a43eb12aff7be142de59f69185d94b71e43ab7c5a6ce4b1f9934

Our copy

gov.uscourts.mdd.538629.30.3.pdf

Original

No public link identified.