Form 943-X - Adjusted Employer'S Annual Federal Tax Return For Agricultural Employees Or Claim For Refund Page 3

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Complete Form 943-X - Adjusted Employer'S Annual Federal Tax Return For Agricultural Employees Or Claim For Refund with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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Name (not your trade name)

Employer identification number (EIN)

Correcting Calendar Year (YYYY)

Part 4:

Explain your corrections for the calendar year you are correcting.

Check here if any corrections you entered on a line include both underreported and overreported amounts.

18.

Explain both your underreported and overreported amounts on line 20.

19.

Check here if any corrections involve reclassified workers. Explain on line 20.

20.

You must give us a detailed explanation for how you determined your corrections. See the instructions.

Part 5:

Sign here. You must complete all three pages of this form and sign it.

Under penalties of perjury, I declare that I have filed an original Form 943 and that I have examined this adjusted return or claim and any schedules or

statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer)

is based on all information of which preparer has any knowledge.

✗

Print your

name here

Sign your

name here

Print your

title here

Date

Best daytime phone

Paid Preparer Use Only

Check if you are self-employed