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pdf941 for 2010:
Form
(Rev. February 2010)
950110
Employer’s QUARTERLY Federal Tax Return
OMB No. 1545-0029
Department of the Treasury — Internal Revenue Service
(EIN)
—
Report for this Quarter of 2010
Employer identification number
(Check one.)
Name (not your trade name)
1: January, February, March
Trade name (if any)
2: April, May, June
3: July, August, September
Address
Number
Street
Suite or room number
City
State
4: October, November, December
ZIP code
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1: Answer these questions for this quarter.
1
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), Dec. 12 (Quarter 4)
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2
Wages, tips, and other compensation
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3
Income tax withheld from wages, tips, and other compensation .
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3
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
5
Taxable social security and Medicare wages and tips:
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Column 1
5b Taxable social security tips
5c Taxable Medicare wages & tips
Check and go to line 6.
Column 2
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5a Taxable social security wages
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.124 =
.124 =
.029 =
5d Total social security and Medicare taxes (Column 2, lines 5a + 5b + 5c = line 5d)
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5d
6
Total taxes before adjustments (lines 3 + 5d = line 6)
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6
7
CURRENT QUARTER’S ADJUSTMENTS, for example, a fractions of cents adjustment.
See the instructions.
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7a Current quarter’s fractions of cents
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7b Current quarter’s sick pay
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7c Current quarter’s adjustments for tips and group-term life insurance
7d TOTAL ADJUSTMENTS. Combine all amounts on lines 7a through 7c .
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7d
8
Total taxes after adjustments. Combine lines 6 and 7d
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8
9
Advance earned income credit (EIC) payments made to employees .
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9
10
Total taxes after adjustment for advance EIC (line 8 – line 9 = line 10) .
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10
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11
Total deposits for this quarter, including overpayment applied
from a prior quarter and overpayment applied from Form 941-X or
Form 944-X . . . . . . . . . . . . . . . . . .
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12a
COBRA premium assistance payments (see instructions)
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12b
Number of individuals provided COBRA premium
assistance reported on line 12a
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13
Add lines 11 and 12a .
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13
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14
Balance due. If line 10 is more than line 13, write the difference here. For information on
how to pay, see the instructions . . . . . . . . . . . . . . . . . . . .
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Overpayment. If line 13 is more than line 10, write the difference here
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Apply to next return.
Check one
You MUST complete both pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 17001Z
Send a refund.
Next
Form 941 (Rev. 2-2010)
950210
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
deposits in multiple states.
16
17 Check one:
Line 10 on this return is less than $2,500 or line 10 on the return for the preceding quarter was less than $2,500, and you
did not incur a $100,000 next-day deposit obligation during the current quarter. Go to Part 3.
You were a monthly schedule depositor for the entire quarter. Enter your tax liability
for each month. Then go to Part 3.
Tax liability:
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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. Complete Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.
Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.
18 If your business has closed or you stopped paying wages .
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Check here, and
19 If you are a seasonal employer and you do not have to file a return for every quarter of the year
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Check here.
enter the final date you paid wages
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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 the IRS.
No.
Part 5: Sign here. You MUST complete both pages of Form 941 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
name here
Sign your
name here
Date
Print your
title here
/
/
Best daytime phone
Paid preparer’s use only
Check if you are self-employed .
Preparer’s name
Preparer’s
SSN/PTIN
Preparer’s signature
Date
Firm’s name (or yours
if self-employed)
EIN
Address
Phone
City
Page 2
State
/
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ZIP code
Form 941 (Rev. 2-2010)
Form 941-V,
Payment Voucher
Complete Form 941-V, Payment Voucher, if you are
making a payment with Form 941, Employer’s
QUARTERLY Federal Tax Return. We will use the
completed voucher to credit your payment more promptly
and accurately, and to improve our service to you.
If you have your return prepared by a third party and
make a payment with that return, please provide this
payment voucher to the return preparer.
Making Payments With Form 941
To avoid a penalty, make your payment with Form 941
only if:
● Your net taxes for either the current quarter or the
preceding quarter (line 10 on Form 941) are less than
$2,500, you did not incur a $100,000 next-day deposit
obligation during the current quarter, and you are paying
in full with a timely filed return or
● You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 (Circular E), Employer's
Tax Guide, for details. In this case, the amount of your
payment may be $2,500 or more.
Otherwise, you must deposit your payment at an
authorized financial institution or by using the Electronic
Federal Tax Payment System (EFTPS). See section 11 of
Pub. 15 (Circular E) for deposit instructions. Do not use
Form 941-V to make federal tax deposits.
Box 1—Employer identification number (EIN). If you do
not have an EIN, apply for one on Form SS-4, Application
for Employer Identification Number, and write “Applied
For” and the date you applied in this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941.
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
one circle.
Box 4—Name and address. Enter your name and
address as shown on Form 941.
● Enclose your check or money order made payable to
the "United States Treasury." Be sure to enter your
EIN, "Form 941," and the tax period on your check or
money order. Do not send cash. Do not staple Form
941-V or your payment to Form 941 (or to each other).
● Detach Form 941-V and send it with your payment
and Form 941 to the address in the Instructions for
Form 941.
Note. You must also complete the entity information
above Part 1 on Form 941.
Payment Voucher
Do
Department of the Treasury
Internal Revenue Service
1
Specific Instructions
Detach Here and Mail With Your Payment and Form 941.
Form
✁
941-V
Caution. Use Form 941-V when making any payment with
Form 941. However, if you pay an amount with Form 941
that should have been deposited, you may be subject to a
penalty. See Deposit Penalties in section 11 of Pub. 15
(Circular E).
4 Enter your business name (individual name if sole proprietor).
1st
Quarter
3rd
Quarter
2nd
Quarter
4th
Quarter
2010
Dollars
Enter the amount of your payment.
3 Tax Period
OMB No. 1545-0029
not staple this voucher or your payment to Form 941.
2
Enter your employer identification
number (EIN).
Enter your address.
Enter your city, state, and ZIP code.
✃
Purpose of Form
Cents
Form 941 (Rev. 2-2010)
Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on Form 941 to carry out the
Internal Revenue laws of the United States. We need it to
figure and collect the right amount of tax. Subtitle C,
Employment Taxes, of the Internal Revenue Code
imposes employment taxes on wages, including income
tax withholding. Form 941 is used to determine the
amount of the taxes that you owe. Section 6011 requires
you to provide the requested information if the tax is
applicable to you. Section 6109 requires filers and paid
preparers to provide their identifying numbers. If you fail
to provide this information in a timely manner, you may be
subject to penalties and interest.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books and records relating to a form or
its instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law.
Generally, tax returns and return information are
confidential, as required by section 6103. However,
section 6103 allows or requires the IRS to disclose or
give the information shown on your tax return to others
as described in the Code. For example, we may
disclose your tax information to the Department of
Justice for civil and criminal litigation, and to cities,
states, the District of Columbia, and U.S. commonwealths
and possessions for use in administering their tax laws.
We may also disclose this information to other countries
under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat
terrorism.
The time needed to complete and file Form 941 will
vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . . . . 12 hr., 39 min.
Learning about the law or the form . . . . . 40 min.
Preparing the form . . . . . . . . . 1 hr., 49 min.
Copying, assembling, and sending
the form to the IRS . . . . . . . . . . . 16 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making Form 941
simpler, we would be happy to hear from you. You can
write to: Internal Revenue Service, Tax Products
Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
Constitution Ave. NW, IR-6526, Washington, DC 20224.
Do not send Form 941 to this address. Instead, see
Where Should You File? on page 4 of the Instructions for
Form 941.
| File Type | application/pdf |
| File Title | Form 941 (Rev. February 2010) |
| Subject | Fillable |
| Author | SE:W:CAR:MP |
| File Modified | 2010-04-20 |
| File Created | 2010-04-20 |