Form 941-V - Preprinted 941-V - Preprinted payment voucher

Version A, Cycle 13

Form 941-V,
Payment Voucher
Purpose of Form
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.

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).

Specific Instructions
• Enter on the voucher the amount paid with
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. Do not send a photocopy of Form 941-V because
your payment may be misapplied or delayed.
If any of the preprinted information is incorrect, make
changes on the top of Form 941, not on the payment
voucher. If you change any of the preprinted
information on the voucher, your payment may be
misapplied or delayed.

DRAFT AS OF
April 28, 2010

d

Detach Here and Mail With Your Payment and Form 941.

Department of the Treasury
Internal Revenue Service
a Do

OMB No. 1545-0029

2010

not staple this voucher or your payment to Form 941.

d





Form 941-V, Payment Voucher
Enter the amount of
your payment . .

Dollars

a

Cents