Form 941-V - Payment Voucher - 2016
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1Form 941-V,
Payment Voucher
Purpose of Form
Specific Instructions
Box 1—Employer identification number (EIN). If you
Complete Form 941-V if you are making a payment with
don't have an EIN, you may apply for one online. Go to
Form 941. We will use the completed voucher to credit
IRS.gov and type “EIN” in the search box. You may also
your payment more promptly and accurately, and to
apply for an EIN by faxing or mailing Form SS-4 to the
improve our service to you.
IRS. If you haven't received your EIN by the due date of
Form 941, write “Applied For” and the date you applied in
Making Payments With Form 941
this entry space.
To avoid a penalty, make your payment with Form 941
Box 2—Amount paid. Enter the amount paid with
only if:
Form 941.
• Your total taxes after adjustments for either the current
Box 3—Tax period. Darken the circle identifying the
quarter or the preceding quarter (Form 941, line 10) are
quarter for which the payment is made. Darken only
less than $2,500, you didn't incur a $100,000 next-day
one circle.
deposit obligation during the current quarter, and you are
Box 4—Name and address. Enter your name and
paying in full with a timely filed return; or
address as shown on Form 941.
• You are a monthly schedule depositor making a
• Enclose your check or money order made payable to
payment in accordance with the Accuracy of Deposits
“United States Treasury.” Be sure to enter your
Rule. See section 11 of Pub. 15 for details. In this case,
EIN, “Form 941,” and the tax period on your check or
the amount of your payment may be $2,500 or more.
money order. Don't send cash. Don't staple Form
941-V or your payment to Form 941 (or to each other).
Otherwise, you must make deposits by electronic funds
transfer. See section 11 of Pub. 15 for deposit
• Detach Form 941-V and send it with your payment
instructions. Don't use Form 941-V to make federal tax
and Form 941 to the address in the Instructions for
deposits.
Form 941.
Use Form 941-V when making any payment with
▲
Note: You must also complete the entity information
!
Form 941. However, if you pay an amount with
above Part 1 on Form 941.
CAUTION
Form 941 that should have been deposited, you
may be subject to a penalty. See Deposit Penalties in
section 11 of Pub. 15.
✁
Detach Here and Mail With Your Payment and Form 941.
▼
▼
941-V
Payment Voucher
OMB No. 1545-0029
2016
Department of the Treasury
Don't 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.
▶
Make your check or money order payable to “United States Treasury”
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 or your city, foreign country name, foreign province/county, and foreign postal code.
Quarter
Quarter
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Parent category: Financial