Instructions For Form 941 - Employer'S Quarterly Federal Tax Return - 2005 Page 4

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file your fully completed Form 941 on time,
Your filing or payment address may have changed
!
from prior years. If you are using an IRS-provided
report your tax liability accurately,
envelope, use only the labels and envelope provided
CAUTION
submit valid checks to the IRS, and
with this tax package. Do not send Form 941 or any
give accurate Forms W-2 to employees and file Copies A
payments to the Social Security Administration (SSA).
of Form W-2 with the Social Security Administration (SSA)
on time and accurately.
If your deposit is late and you have a reasonable cause,
Specific Instructions:
attach an explanation to your return. We will review it when
we process your form and, if you meet the reasonable cause
Part 1: Answer these questions for
requirements, penalties may be abated. (However, do not
attach an explanation for late filing to copies of Form W-2
this quarter
filed with the SSA.) Penalties and interest are charged on
taxes paid late and returns filed late at a rate set by law. See
sections 11 and 12 of Pub. 15 (Circular E) for details.
1. Number of employees who received
Use Form 843, Claim for Refund and Request for
wages, tips, or other compensation this
Abatement, to request abatement of assessed penalties or
quarter
interest. Do not request abatement of assessed penalties or
Tell us the number of employees you paid for the pay period
interest on Form 941 or Form 941c, Supporting Statement
including March 12, June 12, September 12, or December
To Correct Information.
12 for the quarter indicated at the top of the return. Do not
include:
A trust fund recovery penalty may apply if income,
!
household employees,
social security, and Medicare taxes that must be
people who received no pay for the pay period,
withheld are not withheld or paid. The penalty is the
CAUTION
pensioners, or
full amount of the unpaid trust fund tax. This penalty may
active members of the Armed Forces.
apply when these unpaid taxes cannot be collected from the
employer or business. The trust fund recovery penalty may
If you enter “250” or more on line 1, you must file Forms
be imposed on all people the IRS determines to be
W-2 electronically or on magnetic diskette. For details, call
responsible for collecting, accounting for, and paying these
the SSA at 1-800-772-6270 or visit SSA’s Employer
taxes, and who acted willfully in not doing so. For details,
Reporting Instructions and Information website at
see section 11 of Pub. 15 (Circular E).
Where Should You File?
2. Wages, tips, and other compensation
Enter amounts on line 2 that would also be included in box 1
Where you file depends on whether you include a payment
of your employees’ Forms W-2. See the Instructions for
with your form.
Forms W-2 and W-3 for details.
Without a
If you are in . . .
payment . . .
With a payment . . .
If you are an insurance company, do not include sick pay
that you paid to policyholders’ employees here if you gave
Connecticut
New Jersey
Internal Revenue
Internal Revenue
the policyholders timely notice of the payments.
Delaware
New York
Service
Service
District of
North Carolina
Cincinnati, OH
P.O. Box 105703
3. Total income tax withheld from wages,
Columbia
Ohio
45999-0005
Atlanta, GA
Illinois
Pennsylvania
30348-5703
tips, and other compensation
Indiana
Rhode Island
Kentucky
South Carolina
Enter the income tax that you withheld (or were required to
Maine
Vermont
withhold) from your employees on this quarter’s wages, tips,
Maryland
Virginia
taxable fringe benefits, and supplemental unemployment
Massachusetts
West Virginia
compensation benefits. Also include here any excise taxes
Michigan
Wisconsin
New Hampshire
that you were required to withhold on golden parachute
payments (section 4999).
Alabama
Missouri
Internal Revenue
Internal Revenue
Alaska
Montana
Service
Service
If you are an insurance company, enter the income tax
Arizona
Nebraska
Ogden, UT
P.O. Box 660264
that you withheld (or were required to withhold) on
Arkansas
Nevada
84201-0005
Dallas, TX
third-party sick pay here.
California
New Mexico
75266-0264
Colorado
North Dakota
4. If no wages, tips, and compensation on
Florida
Oklahoma
Georgia
Oregon
line 2 are subject to social security or
Hawaii
South Dakota
Idaho
Tennessee
Medicare tax . . .
Iowa
Texas
If no wages, tips, and compensation on line 2 are subject to
Kansas
Utah
Louisiana
Washington
social security and Medicare taxes, check the box on line 4.
Minnesota
Wyoming
If this question does not apply to you, leave the box blank.
Mississippi
For more information about exempt wages, see section 15
of Pub. 15 (Circular E) and section 4 of Pub. 15-A,
No legal residence or principal
Internal Revenue
Internal Revenue
Employer’s Supplemental Tax Guide.
place of business in any state
Service
Service
Philadelphia, PA
P.O. Box 80106
19255-0005
Cincinnati, OH
If you are a government employer, wages that you
45280-0006
!
pay are not automatically exempt from social security
Special rule for Exempt
Internal Revenue
Internal Revenue
and Medicare taxes. Your employees may be
CAUTION
Organizations, Federal, State and Service
Service
covered by law or by a voluntary Section 218 Agreement
Local Governmental Entities, and Ogden, UT
P.O. Box 660264
with SSA. For more information, see Pub. 963,
Indian Tribal Governmental
84201-0046
Dallas, TX
Federal-State Reference Guide.
Entities, regardless of location
75266-0264
-4-

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