Form 941 - Employer'S Quarterly Federal Tax Return, Form 941-V - Payment Voucher - 2011 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, apply for one on Form SS-4, Application
payment voucher to the return preparer.
for Employer Identification Number, and write “Applied
For” and the date you applied in this entry space.
Making Payments With Form 941
Box 2—Amount paid. Enter the amount paid with
To avoid a penalty, make your payment with Form 941
Form 941.
only if:
Box 3—Tax period. Darken the circle identifying the
• Your net taxes for either the current quarter or the
quarter for which the payment is made. Darken only
preceding quarter (line 10 on Form 941) are less than
one circle.
$2,500, you did not incur a $100,000 next-day deposit
Box 4—Name and address. Enter your name and
obligation during the current quarter, and you are paying
address as shown on Form 941.
in full with a timely filed return, or
• Enclose your check or money order made payable to
• You are a monthly schedule depositor making a
the "United States Treasury." Be sure to enter your
payment in accordance with the Accuracy of Deposits
EIN, "Form 941," and the tax period on your check or
Rule. See section 11 of Pub. 15 (Circular E), Employer's
money order. Do not send cash. Do not staple Form
Tax Guide, for details. In this case, the amount of your
941-V or your payment to Form 941 (or to each other).
payment may be $2,500 or more.
• Detach Form 941-V and send it with your payment
Otherwise, you must make deposits by electronic funds
and Form 941 to the address in the Instructions for
transfer. See section 11 of Pub. 15 (Circular E) for deposit
Form 941.
instructions. Do not use Form 941-V to make federal tax
Note. You must also complete the entity information
deposits.
above Part 1 on Form 941.
✁
Detach Here and Mail With Your Payment and Form 941.
▼
▼
941-V
Payment Voucher
OMB No. 1545-0029
2011
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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