Form 941-Ss - Employer'S Quarterly Federal Tax Return - American Samoa, Guam, The Commonwealth Of The Northern Mariana Islands, And The U.s. Virgin Islands - 2015 Page 3

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Form 941-V(SS),
Payment Voucher
Purpose of Form
Specific Instructions
Box 1—Employer identification number (EIN). If you
Complete Form 941-V(SS), Payment Voucher, if you
are making a payment with Form 941-SS, Employer’s
do not have an EIN, you may apply for one online. Go to
QUARTERLY Federal Tax Return. We will use the
IRS.gov and type "EIN" in the search box. You may also
completed voucher to credit your payment more
apply for an EIN by faxing or mailing Form SS-4,
promptly and accurately, and to improve our service to
Application for Employer Identification Number, to the
you.
IRS. If you have not received your EIN by the due date of
Form 941-SS, write “Applied For” and the date you
Making Payments With Form 941-SS
applied in this entry space.
To avoid a penalty, make your payment with Form
Box 2—Amount paid. Enter the amount paid with
941-SS only if:
Form 941-SS.
• Your total taxes after adjustments for either the current
Box 3—Tax period. Darken the circle identifying the
quarter or the preceding quarter (Form 941-SS, line 10)
quarter for which the payment is made. Darken only
are less than $2,500, you did not incur a $100,000
one circle.
next-day deposit obligation during the current quarter,
Box 4—Name and address. Enter your name and
and you are paying in full with a timely filed return, or
address as shown on Form 941-SS.
• You are a monthly schedule depositor making a
• Enclose your check or money order payable to the
payment in accordance with the Accuracy of Deposits
“United States Treasury.” Be sure to enter your EIN,
Rule. See section 8 of Pub. 80 (Circular SS), Federal
“Form 941-SS,” and the tax period on your check or
Tax Guide for Employers in the U.S. Virgin Islands, Guam,
money order. Do not send cash. Do not staple Form
American Samoa, and the Commonwealth of the
941-V(SS) or your payment to Form 941-SS (or to each
Northern Mariana Islands, for details. In this case, the
other).
amount of your payment may be $2,500 or more.
• Detach Form 941-V(SS) and send it with your
Otherwise, you must make deposits by electronic funds
payment and Form 941-SS to the address in the
transfer. See section 8 of Pub. 80 (Circular SS) for deposit
Instructions for Form 941-SS.
instructions. Do not use Form 941-V(SS) to make federal
tax deposits.
Note. You must also complete the entity information
above Part 1 on Form 941-SS.
Caution. Use Form 941-V(SS) when making any
payment with Form 941-SS. However, if you pay an
amount with Form 941-SS that should have been
deposited, you may be subject to a penalty. See
Deposit Penalties in section 8 of Pub. 80 (Circular SS).
✁
Detach Here and Mail With Your Payment and Form 941-SS.
▼
▼
941-V(SS)
Payment Voucher
OMB No. 1545-0029
2015
Department of the Treasury
Do not staple this voucher or your payment to Form 941-SS.
▶
Internal Revenue Service
1 Enter your employer identification
2
Dollars
Cents
number (EIN).
Enter the amount of your payment.
▶
Make your check or money order payable to “United States Treasury”
3 Tax period
4 Enter your business name (individual name if sole proprietor).
1st
3rd
Quarter
Quarter
Enter your address.
2nd
4th
Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code.
Quarter
Quarter

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