Please scroll down for the form at the bottom of this page. Review the form for accuracy. Remember to detach the form before mailing to the agency. (CUT HERE) z STATE OF RHODE ISLAND DIVISION OF TAXATION • DEPTII00 • PO BOX 9/03 • PROVIDENCE. RI 029/0.9703 I HEREBY CERTIFY THAT THIS RETURN. TOME BEST OF MY KNOWLEDGE AND BELIEF. IS A TRUE CORRECT AND COMPLETE RETURN. SIGNATURE OF OWNER. PARTNER OR AUTHORIZED AGENT TITLE DATE • ACCOUNT IDENTIFICATION NUMBER RETURN FOR QUARIERMONTHLY PERIOD ENDING WTQM TAX AMOUNT DUE AND PAID WITHHOLDING TAX RETURN • QUARTER/MONTHLY NI-QMR1 REV 11199 EFTA01219702