Form 941 - Employer'S Quarterly Federal Tax Return, Form 941-V - Payment Voucher - 2007 Page 2
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4990207
Name (not your trade name)
Employer identification number (EIN)
Part 2: Tell us about your deposit schedule and tax liability for this quarter.
If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see Pub. 15
(Circular E), section 11.
Write the state abbreviation for the state where you made your deposits OR write “MU” if you made your
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deposits in multiple states.
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Check one:
Line 10 is less than $2,500. Go to Part 3.
You were a monthly schedule depositor for the entire quarter. Fill out your tax
liability for each month. Then go to Part 3.
.
Tax liability:
Month 1
.
Month 2
.
Month 3
.
Total liability for quarter
Total must equal line 10.
You were a semiweekly schedule depositor for any part of this quarter. Fill out Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to this form.
Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.
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If your business has closed or you stopped paying wages
Check here, and
/
/
enter the final date you paid wages
.
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If you are a seasonal employer and you do not have to file a return for every quarter of the year
Check here.
Part 4: May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? (See the instructions
for details.)
Yes. Designee’s name
Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS.
No.
Part 5: Sign here. You MUST fill out both pages of this form and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief, it is true, correct, and complete.
Print your
name here
Sign your
name here
Print your
title here
Best daytime phone (
)
–
/
/
Date
Part 6: For paid preparers only (optional)
Paid Preparer’s
Signature
Firm’s name
Address
EIN
ZIP code
Phone (
)
–
/
/
Date
SSN/PTIN
Check if you are self-employed.
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941
Page
Form
(Rev. 1-2007)
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