Form 941 - Payment Voucher - 2003 (Page 2 of 7) in pdf

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 your payment with Form 941 only if:

address as shown on Form 941.

● Your net taxes for the quarter (line 13 on Form 941)

● Enclose your check or money order made payable to

are less than $2,500 and you are paying in full with a

the “United States Treasury.” Be sure also to enter

timely filed return or

your EIN, “Form 941,” and the tax period on your

● You are a monthly schedule depositor making a

check or money order. Do not send cash. Please do

payment in accordance with the Accuracy of

not staple this voucher or your payment to the return

Deposits Rule. (See section 11 of Circular E (Pub.

(or to each other).

15), Employer’s Tax Guide, for details.) This amount

● Detach the completed voucher and send it with your

may be $2,500 or 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 (Pub. 15) 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 Deposit Penalties in section 11 of

Circular E (Pub. 15).

941-V

Form

(2003)

Detach Here and Mail With Your Payment and Tax Return.

941-V

Payment Voucher

OMB No. 1545-0029

2003

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 your 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

Form 941 - Payment Voucher - 2003 Page 2

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