Form 943 - Employer'S Annual Federal Tax Return For Agricultural Employees - 2012

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943
OMB No. 1545-0035
Employer’s Annual Federal Tax Return for Agricultural Employees
Form
2012
Department of the Treasury
Information about Form 943 and its separate instructions is at
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Internal Revenue Service
Name (as distinguished from trade name)
Calendar year
Type
Trade name, if any
Employer identification number (EIN)
or
If address is
Print
different from
Address (number and street)
City, state, and ZIP code
prior return,
check here.
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If you do not have to file returns in the future, check here
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1
1
Number of agricultural employees employed in the pay period that includes March 12, 2012
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For 2012, the employee social security tax rate is 4.2% and the Medicare tax rate is 1.45%. The employer social security tax rate
is 6.2% and the Medicare tax rate is 1.45%.
2
Total wages subject to social security tax (see separate instructions)
2
3
3
Social security tax (multiply line 2 by 10.4% (.104)) .
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4
Total wages subject to Medicare tax (see separate instructions) .
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4
5
Medicare tax (multiply line 4 by 2.9% (.029))
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5
6
6
Federal income tax withheld (see separate instructions)
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7
Total taxes before adjustments. Add lines 3, 5, and 6
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7
8
Current year’s adjustments (see separate instructions) .
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8
9
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Total taxes after adjustments (line 7 as adjusted by line 8) .
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10
Total deposits for 2012, including overpayment applied from a prior year and Form 943-X .
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10
11a COBRA premium assistance payments (see separate instructions) .
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11a
11b Number of individuals provided COBRA premium assistance .
11b
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12
Add lines 10 and 11a .
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12
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Balance due. If line 9 is more than 12, enter the difference and see the instructions
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14
Overpayment. If line 12 is more than line 9, enter the difference
Check one:
Appy to next return.
Send a refund.
$
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• All filers: If line 9 is less than $2,500, do not complete line 15 or Form 943-A.
• Semiweekly schedule depositors: Complete Form 943-A and check here
• Monthly schedule depositors: Complete line 15 and check here
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Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)
15
Tax liability for month
Tax liability for month
Tax liability for month
A January .
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F
June .
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K November .
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B February .
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G July .
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L
December .
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C March
H August
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M Total
liability
for
year (add lines A
D April .
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I
September .
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through L)
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E May .
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J
October .
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Third-
Do you want to allow another person to discuss this return with the IRS (see separate instructions)?
Yes. Complete the following.
No.
Party
Designee’s
Phone
Personal identification
Designee
name
no.
number (PIN)
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
Sign
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here
Print Your
Signature
Name and Title
Date
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Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm’s EIN
Use Only
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Firm’s address
Phone no.
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943
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Form
(2012)
Cat. No. 11252K

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