03-25-19 Regular Meeting of the La Porte Development Corporation Board

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970217 Form 941 (Rev. 1-2018) Page 2 Name (not your trade name) Employer identification number (EIN) MENDEL 76 SOUTHEAST TX INVESTMENTS, LLC 1 822039870 Tell us about your deposit schedule and tax liability for this quarter. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was loss than $2,500, and you 16 Check one: Eldidn'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 federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3. You were 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 liability. Month 1 Month 2 Month 3 Total liability for quarter Total must equal line 12. F0 You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax 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 .......... I ...................... . �Check here, and enter the final date you paid wages I - 18 if you are a seasonal employer and you don't have to file a return for every quarter of the year............ Check here. May we speak with your third -party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See instructions for details. Yes. Designee's name and phone number Tina Hoffman 281-491-1400 FISelect a 6 -digit Personal Identification Number (PIN) to use when talking to the IRS. No. Sign here. You MUST complete both pages of Form 941 and SIGN it. Under penalties of perjury, I declare that I 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 all information of which preparer has any knowledge. Print your - Tina Hoffman Sign your name here name here X Print your title here I Affiliated Payroll Services, LLC Date 01/12/2019 Best daytime phone 1 281-491-1400 CAA B189412 NTF 2582100 8 9412 Paid Preparer Use Only Check if you are self-employed.......... Preparer's name T Hoffman PTIN P01350836 01/12/2019 Preparer's signature Date Firm's name (or yours Payroll Services770672303 , LLC EIN if self-employed) F-Aw- I Address 4655 Techniplex Dr.,Suite #100 Phone 281-491-1400 T74 City Stafford State TX 7 ZIP code 777 F _