Form 2501 is used to report the estate of a deceased individual to the Internal Revenue Service. The form must be filed regardless of the size or value of the estate. There are several specific instances where Form 2501 must be filed, even if there is no estate to report.Failure to file this form may result in penalties and interest charges. This article will provide an overview of Form 2501 and instructions on how to file it.
| Question | Answer |
|---|---|
| Form Name | Cem 2501 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | california cem 2501, state of california cem 2501, cem 2501 fringe benefit statement, cem 2501 fillable |
STATE OF CALIFORNIA · DEPARTMENT OF TRANSPORTATION
FRINGE BENEFIT STATEMENT
CONTRACTOR OR SUBCONTRACTOR (Please Print) |
CONTRACT NUMBER |
DATE |
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ABC Contractors Inc - CT office |
Proj#2 |
08/01/2012 |
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TO: RESIDENT ENGINEER OR DISTRICT LABOR COMPLIANCE OFFICER |
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BUSINESS ADDRESS |
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California Dept. Of Transportation |
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123 Some Street |
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Sacramento Office |
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Suite 100 |
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Sometown, CA 99999 |
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Labor Compliance uses the following fringe benefits information (shown or referenced on wage rate determinations) paid to or on behalf of employees in various crafts or classifications to check payrolls or apply to force account work on the above contract.
COMPLETE AND SUBMIT THIS FORM WITH THE FIRST CERTIFIED PAYROLL OR WHEN THERE HAVE BEEN CHANGES.
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Classification |
Fringe Benefit Hourly Amount |
Name and Address of Plan, Fund, or Program |
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Heavy Equipment Operator |
Vacation |
$ |
0.00 |
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Capitol Blue Cross/BlueShield |
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Group #123321 |
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Effective Date |
Health and |
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$ |
10.50 |
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12 Main Street |
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01/01/2012 |
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Welfare |
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Town, ST ZIP |
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0.00 |
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Pension |
$ |
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Subsistence and/or Travel Pay |
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Apprentice or |
$ |
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0.00 |
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Training Fees |
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$0.00 |
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Other |
$ |
0.00 |
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Classification |
Fringe Benefit Hourly Amount |
Name and Address of Plan, Fund, or Program |
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Heavy Highway Labor |
Vacation |
$ |
0.00 |
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Capitol Blue Cross/BlueShield |
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Group #123321 |
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Effective Date |
Health and |
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$ |
10.50 |
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12 Main Street |
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01/01/2012 |
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Welfare |
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Town, ST ZIP |
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0.00 |
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Pension |
$ |
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Subsistence and/or Travel Pay |
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Apprentice or |
$ |
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0.00 |
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Training Fees |
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$0.00 |
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Other |
$ |
0.00 |
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Classification |
Fringe Benefit Hourly Amount |
Name and Address of Plan, Fund, or Program |
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Heavy Highway Pipe Fitter |
Vacation |
$ |
0.00 |
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Capitol Blue Cross/BlueShield |
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Group #123321 |
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Effective Date |
Health and |
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$ |
10.50 |
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12 Main Street |
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01/01/2002 |
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Welfare |
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Town, ST ZIP |
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Pension |
$ |
0.00 |
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Subsistence and/or Travel Pay |
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Apprentice or |
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$ |
0.00 |
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Training Fees |
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$0.00 |
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Other |
$ |
0.00 |
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I certify under penalty of perjury that fringe benefits are paid to the approved Plans, Funds, or Programs listed above. |
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NAME AND TITLE (PLEASE PRINT.) |
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John Smith, President |
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SIGNATURE |
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BUSINESS TELEPHONE NUMBER |
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(555) |
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ADA Notice |
For individuals with sensory disabilities, this document is available in alternate formats. For more information call (916) |
CEM2501 |
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or TDD (916) |
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