Instructions For Form 941 - Employer'S Quarterly Federal Tax Return

Form 941

Payment Voucher

Purpose of Form

Specific Instructions

Complete Form 941-V if you are making a payment

Box 1—Employer identification number (EIN). If you

with Form 941, Employer’s Quarterly Federal Tax

do not have an EIN, apply for one on Form SS-4,

Return. We will use the completed voucher to credit

Application for Employer Identification Number, and

your payment more promptly and accurately, and to

write “Applied for” and the date you applied in this

improve our service to you.

entry space.

If you have your return prepared by a third party and

Box 2—Amount paid. Enter the amount paid with

make a payment with that return, please provide this

Form 941.

payment voucher to the return preparer.

Box 3—Tax period. Darken the capsule identifying the

quarter for which the payment is made. Darken only

Making Payments With Form 941

one capsule.

Box 4—Name and address. Enter your name and

Make payments with Form 941 only if:

address as shown on Form 941.

1. Your net taxes for the quarter (line 13 on Form

● Make your check or money order payable to the

941) are less than $2,500 and you are paying in full

United States Treasury. Be sure to enter your EIN,

with a timely filed return or

“Form 941,” and the tax period on your check or

2. You are a monthly schedule depositor making a

money order. Do not send cash. Please do not staple

payment in accordance with the accuracy of deposits

this voucher or your payment to the return or to each

rule. (See section 11 of Circular E, Employer’s Tax

other.

Guide, for details.) This amount may be $2,500 or

● Detach the completed voucher and send it with your

more.

payment and Form 941 to the address provided on the

Otherwise, you must deposit the amount at an

back of Form 941.

authorized financial institution or by electronic funds

transfer. (See section 11 of Circular E for deposit

instructions.) Do not use the Form 941-V payment

voucher to make Federal tax deposits.

Caution: If you pay amounts with For m 941 that

should have been deposited, you may be subject to a

penalty. See Circular E.

941-V

Form

(2002)

Detach Here and Mail With Your Payment

941-V

Payment Voucher

OMB No. 1545-0029

2002

Department of the Treasury

Do not staple or attach this voucher to your payment.

(99)

Internal Revenue Service

Enter your employer identification

Dollars

Cents

number

Enter the amount of the payment

3 Tax period

4 Enter your business name (individual name if sole proprietor)

1st

3rd

Enter your address

Quarter

2nd

4th

Enter your city, state, and ZIP code

Quarter

Instructions For Form 941 - Employer'S Quarterly Federal Tax Return - 2002 Page 2

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