Form 944 - Employer'S Annual Federal Tax Return - 2017 Page 2

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Name (not your trade name)
Employer identification number (EIN)
Part 2:
Tell us about your deposit schedule and tax liability for this year.
13 Check one:
Line 9 is less than $2,500. Go to Part 3.
Line 9 is $2,500 or more. Enter your tax liability for each month. If you are a semiweekly depositor or you accumulate
$100,000 or more of liability on any day during a deposit period, you must complete Form 945-A instead of the boxes below.
Jan.
Apr.
Jul.
Oct.
.
.
.
.
13a
13d
13g
13j
Feb.
May
Aug.
Nov.
.
.
.
.
13b
13e
13h
13k
Mar.
Jun.
Sep.
Dec.
.
.
.
.
13c
13f
13i
13l
.
Total liability for year. Add lines 13a through 13l. Total must equal line 9.
13m
Part 3:
Tell us about your business. If question 14 does NOT apply to your business, leave it blank.
14 If your business has closed or you stopped paying wages...
Check here and enter the final date you paid wages.
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 and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS.
No.
Part 5:
Sign Here. You MUST complete both pages of Form 944 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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Print your
Sign your
name here
name here
Print your
title here
Date
Best daytime phone
Paid Preparer Use Only
Check if you are self-employed
Preparer’s name
PTIN
Preparer’s signature
Date
Firm’s name (or yours
EIN
if self-employed)
Address
Phone
City
State
ZIP code
2
944
Page
Form
(2017)

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