Form 941 - Employer'S Quarterly Federal Tax Return, Form 941-V - Payment Voucher - 2012 Page 3
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4Form 941-V,
Payment Voucher
Purpose of Form
Caution. Use Form 941-V when making any payment with
Form 941. However, if you pay an amount with Form 941
Complete Form 941-V, Payment Voucher, if you are
that should have been deposited, you may be subject to a
making a payment with Form 941, Employer’s
penalty. See Deposit Penalties in section 11 of Pub. 15
QUARTERLY Federal Tax Return. We will use the
(Circular E).
completed voucher to credit your payment more promptly
Specific Instructions
and accurately, and to improve our service to you.
If you have your return prepared by a third party and
Box 1—Employer identification number (EIN). If you do
make a payment with that return, please provide this
not have an EIN, you may apply for one online. Go to
payment voucher to the return preparer.
IRS.gov and click on the Apply for an EIN Online link. You
may also apply for an EIN by calling 1-800-829-4933, or
Making Payments With Form 941
you can fax or mail Form SS-4, Application for Employer
Identification Number. If you have not received your EIN
To avoid a penalty, make your payment with Form 941
by the due date of Form 941, write “Applied For” and the
only if:
date you applied in this entry space.
• Your net taxes for either the current quarter or the
Box 2—Amount paid. Enter the amount paid with
preceding quarter (line 10 on Form 941) are less than
Form 941.
$2,500, you did not incur a $100,000 next-day deposit
obligation during the current quarter, and you are paying
Box 3—Tax period. Darken the circle identifying the
in full with a timely filed return, or
quarter for which the payment is made. Darken only
one circle.
• You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Box 4—Name and address. Enter your name and
Rule. See section 11 of Pub. 15 (Circular E), Employer's
address as shown on Form 941.
Tax Guide, for details. In this case, the amount of your
• Enclose your check or money order made payable to
payment may be $2,500 or more.
the "United States Treasury." Be sure to enter your
Otherwise, you must make deposits by electronic funds
EIN, "Form 941," and the tax period on your check or
transfer. See section 11 of Pub. 15 (Circular E) for deposit
money order. Do not send cash. Do not staple Form
instructions. Do not use Form 941-V to make federal tax
941-V or your payment to Form 941 (or to each other).
deposits.
• Detach Form 941-V and send it with your payment
and Form 941 to the address in the Instructions for
Form 941.
Note. You must also complete the entity information
above Part 1 on Form 941.
✁
Detach Here and Mail With Your Payment and Form 941.
▼
▼
941-V
Payment Voucher
OMB No. 1545-0029
2012
Department of the Treasury
Do not staple this voucher or your payment to Form 941.
▶
Internal Revenue Service
1 Enter your employer identification
2
Dollars
Cents
number (EIN).
Enter the amount of your payment.
▶
4 Enter your business name (individual name if sole proprietor).
3 Tax Period
1st
3rd
Enter your address.
Quarter
Quarter
2nd
4th
Enter your city, state, and ZIP code.
Quarter
Quarter
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Parent category: Financial