Form 941-V (SS) 941-V (SS) Payment Voucher

MAILOUT

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 941-SS, PAGE 3 of 4 (Mailout)
MARGINS: TOP 13 mm (1⁄2 ") CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 279 mm (11")
PERFORATE: 3.25" FROM BOTTOM
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Layer 1 prints black

Layer 3 prints 185 red

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Form 941-V(SS),
Payment Voucher
Purpose of Form

Complete Form 941-V(SS), Payment Voucher, if you
are making a payment with Form 941-SS, 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-SS

To avoid a penalty, make your payment with Form
941-SS only if:
● Your net taxes for either the current quarter or the
preceding quarter (line 8 on Form 941-SS) 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 8 of Pub. 80 (Circular SS), Federal
Tax Guide for Employers in the U.S. Virgin Islands,
Guam, American Samoa, and the Commonwealth of the
Northern Mariana Islands, 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 8 of
Circular SS for deposit instructions. Do not use Form
941-V(SS) to make federal tax deposits.

Caution. Use Form 941-V(SS) when making any
payment with Form 941-SS. However, if you pay an
amount with Form 941-SS that should have been
deposited, you may be subject to a penalty. See
Deposit Penalties in section 8 of Pub. 80 (Circular SS).

Specific Instructions

● Enter on the voucher the amount paid with Form
941-SS.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure to enter your EIN,
“Form 941-SS,” and the tax period on your check or
money order. Do not send cash. Do not staple Form
941-V(SS) or your payment to Form 941-SS (or to each
other).
● Detach Form 941-V(SS) and send it with your
payment and Form 941-SS to the address in the
Instructions for Form 941-SS. Do not send a photocopy
of Form 941-V(SS) because your payment may be
misapplied or delayed.
If any of the preprinted information is incorrect, make
changes on the top of Form 941-SS, not on the
payment voucher. If you change any of the preprinted
information on the voucher, your payment may be
misapplied or delayed.

Pub. 80 (Circular SS)





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Detach Here and Mail With Your Payment and Form 941-SS. 

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0029

2010

Form 941-V(SS), Payment Voucher

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

Enter the amount of
your payment

Dollars


Cents