Form 943-A - Agricultural Employer'S Record Of Federal Tax Liability
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4943-A
Agricultural Employer's Record of
OMB No. 1545-0035
Form
Federal Tax Liability
(Rev. October 2017)
Go to for the latest information.
▶
Department of the Treasury
File with Form 943 or Form 943-X.
Calendar Year
Internal Revenue Service
▶
Employer identification number (EIN)
Name (as shown on Form 943)
You must complete this form if you're a semiweekly schedule depositor or became one because your accumulated tax liability during
any month was $100,000 or more. Show tax liability here, not deposits. (The IRS gets deposit data from electronic funds transfers.)
Don't change your current year tax liability by adjustments reported on any Forms 943-X.
January Tax Liability
February Tax Liability
March Tax Liability
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A Total liability for month
B Total liability for month
C Total liability for month
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April Tax Liability
May Tax Liability
June Tax Liability
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D Total liability for month
E Total liability for month
F Total liability for month
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943-A
For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions for Form 943.
Cat. No. 17030C
Form
(Rev. 10-2017)
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