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1% PER MONTH ON THE BALANCE DUE AFTER THE DUE DATE) TOTAL: ADD LINE 1 AND LINE 2 LESS: MONTHLY OR OTHER DEPOSITORY PAYMENTS MADE THIS QUARTER AMOUNT DUE WITH THIS RETURN (LINE 3 MINUS LINE 4) MAKE CHECK PAYABLE TO: CTCB There will be a $25.00 fee for returned checks. There may be additional collection fees if payment is not enclosed with this form at the time of filing. $ TAX OFFICE USE ONLY - DO NOT WRITE IN THIS AREA $ $ $ $ TOTAL PAGES THIS RETURN: _____ EMPLOYER'S NAME & ADDRESS EMPLO.

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