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Form 941-V,

Payment Voucher

Purpose of Form

Caution. Use Form 941-V when making any payment with

Form 941. However, if you pay an amount with Form 941

Complete Form 941-V, Payment Voucher, if you are

that should have been deposited, you may be subject to a

making a payment with Form 941, Employer’s

penalty. See Deposit Penalties in section 11 of Pub. 15

QUARTERLY Federal Tax Return. We will use the

(Circular E).

completed voucher to credit your payment more promptly

Specific Instructions

and accurately, and to improve our service to you.

If you have your return prepared by a third party and

Box 1—Employer identification number (EIN). If you do

make a payment with that return, please provide this

not have an EIN, apply for one on Form SS-4, Application

payment voucher to the return preparer.

for Employer Identification Number, and write “Applied

For” and the date you applied in this entry space.

Making Payments With Form 941

Box 2—Amount paid. Enter the amount paid with

To avoid a penalty, make your payment with Form 941

Form 941.

only if:

Box 3—Tax period. Darken the circle identifying the

● Your net taxes for the quarter (line 10 on Form 941)

quarter for which the payment is made. Darken only

are less than $2,500 and you are paying in full with a

one circle.

timely filed return or

Box 4—Name and address. Enter your name and

● You are a monthly schedule depositor making a

address as shown on Form 941.

payment in accordance with the Accuracy of Deposits

● Enclose your check or money order made payable to

Rule. See section 11 of Pub. 15 (Circular E), Employer's

the "United States Treasury." Be sure to enter your

Tax Guide, for details. In this case, the amount of your

EIN, "Form 941," and the tax period on your check or

payment may be $2,500 or more.

money order. Do not send cash. Do not staple Form

Otherwise, you must deposit your payment at an

941-V or your payment to Form 941 (or to each other).

authorized financial institution or by using the Electronic

● Detach Form 941-V and send it with your payment

Federal Tax Payment System (EFTPS). See section 11 of

and Form 941 to the address in the Instructions for

Pub. 15 (Circular E) for deposit instructions. Do not use

Form 941.

Form 941-V to make federal tax deposits.

Note. You must also complete the entity information

above Part 1 on Form 941.

Detach Here and Mail With Your Payment and Form 941.

941-V

Payment Voucher

OMB No. 1545-0029

2010

Department of the Treasury

Do not staple this voucher or your payment to Form 941.

Internal Revenue Service

1 Enter your employer identification

Dollars

Cents

number (EIN).

Enter the amount of your payment.

4 Enter your business name (individual name if sole proprietor).

3 Tax Period

1st

3rd

Enter your address.

Quarter

2nd

4th

Enter your city, state, and ZIP code.

Quarter

Form 941 Draft - Employer'S Quarterly Federal Tax Return, Form 941-V Draft - Payment Voucher - 2010 Page 4

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