Form 943-A - Agricultural Employer'S Record Of Federal Tax Liability

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943-A
Agricultural Employer's Record of
OMB No. 1545-0035
Form
Federal Tax Liability
(Rev. December 2013)
Information about Form 943-A and its instructions is at
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 are required to deposit on a semiweekly schedule or if your 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.) DO NOT change
your tax liability by adjustments reported on any Forms 943-X.
January Tax Liability
February Tax Liability
March Tax Liability
1
16
1
16
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16
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A Total liability for month
B Total liability for month
C Total liability for month
April Tax Liability
May Tax Liability
June Tax Liability
1
16
1
16
1
16
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17
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17
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17
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18
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D Total liability for month
E Total liability for month
F Total liability for month
943-A
For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions for Form 943.
Cat. No. 17030C
Form
(Rev. 12-2013)

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