<?xml version="1.0" encoding="UTF-8"?>
<StateAnnual xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile
H:\FSET\FSETv02.0\StateSchemas\StateAnnual.xsd">
	<ReturnHeader>
		<ElectronicPostmark>2004-10-25T15:30:00</ElectronicPostmark>
		<DueDate>2005-01-31</DueDate>
		<SoftwareId>12341234</SoftwareId>
		<ReturnType>StateWH</ReturnType>
		<FilingAction>
			<Action>Original</Action>
		</FilingAction>
		<TIN>
			<TypeTIN>FEIN</TypeTIN>
			<TINTypeValue>123456789</TINTypeValue>
		</TIN>
		<StateEIN>
			<TypeStateEIN>WithholdingAccountNo</TypeStateEIN>
			<StateEINValue>123456-8</StateEINValue>
		</StateEIN>
		<BusinessAddress>
			<BusinessName>Scott's Tool Shop</BusinessName>
		</BusinessAddress>
		<Preparer>
			<Name>Scott H Mueller</Name>
			<SSN>123456789</SSN>
			<Phone>6082668518</Phone>
			<EmailAddress>scott.mueller@revenue.wi.gov</EmailAddress>
		</Preparer>
		<ReturnSigner>
			<Name>Scott H Mueller</Name>
			<Title>Figurehead</Title>
			<Phone>6062668518</Phone>
			<EmailAddress>scott.mueller@revenue.wi.gov</EmailAddress>
			<Signature>6085551212</Signature>
			<DateSigned>2004-10-28</DateSigned>
		</ReturnSigner>
		<Contact>
			<ContactName>
				<Title>President</Title>
				<FullName>Scott H Mueller</FullName>
			</ContactName>
			<Phone>6082668518</Phone>
			<Fax>6082649923</Fax>
			<EmailAddress>scott.mueller@revenue.wi.gov</EmailAddress>
		</Contact>
		<AckAddress>scott.mueller@revenue.wi.gov</AckAddress>
	</ReturnHeader>
	<TaxYear>2004</TaxYear>
	<SubmitW2>3</SubmitW2>
	<NumberOfRecords>10</NumberOfRecords>
	<TotalWagesYear>430554.16</TotalWagesYear>
	<TotalIncomeTaxWithheld>25839.89</TotalIncomeTaxWithheld>
	<WHBalanceDue>0</WHBalanceDue>
	<LiabilityPeriodAmount Period="1">25839.89</LiabilityPeriodAmount>
	<AmountWithheld1stQuarter>7563.24</AmountWithheld1stQuarter>
	<AmountWithheld2ndQuarter>5931.54</AmountWithheld2ndQuarter>
	<AmountWithheld3rdQuarter>6891.55</AmountWithheld3rdQuarter>
	<AmountWithheld4thQuarter>5453.56</AmountWithheld4thQuarter>
</StateAnnual>
