Form 940 (1986) Page 4
Computation of Tentative Credit (Complete if you checked the “No” box in either question A or B or you checked the box in C, on page 1—see instructions.)
Name [State reporting number(s)| _Tayable payroll [State ex] Contributions if | Contributions | Additional credit | Contributions

of | as shown on employer's | (as defined vn state act) State experience rate period Perience| rate had been 5.494 payable at experence | (col. 6 minus col.7)| actually paid to
state | state contribution returns 4 rate (col. 3x.054) | rate (col. 3xcol. 5) | IfOorless, enter 0. state

1 2 3 From— To— 5 6 7 8 9
10 Totals. > y

11 Total tentative credit (add line 10, columns 8 and 9—see instructions for limitations)

>

Part |.—Computation of Taxable Wages
and Credit Reduction

Line 1—Total payments.—Enter the total
payments you made to employees during the
calendar year, even if they are not taxable.
Include salaries, wages, commissions, fees,
bonuses, vacation allowances, amounts paid to
temporary or part-time employees, and the value
of goods, lodging, food, clothing, and noncash
fringe benefits. Enter the amount before any
deductions.

How the payments are made is not important
in determining if they are wages. Thus, you may
pay wages for piecework or as a percentage of
profits, and you may pay wages hourly, daily,
weekly, monthly, or yearly. You may pay wages in
cash or some other way, such as goods, lodging,
food, or clothing. For items other than cash, use
the fair market value at the time of payment.
Line 2—Exempt payments.— Wages” and
“employment” as defined for FUTA purposes do
not include every payment and every kind of service
an employee may perform. In general, payments
excluded from wages and payments for services
excepted from employment are not subject to tax.
You may deduct these payments from total
payments only if you explain them on line 2.

Enter such items as the following:

(1) Agricultural labor, if you didn’t meet either
of the tests in Agricultural Employer on page 2.

(2) Benefit payments for sickness or injury
under a worker's compensation law.

(3) Household service if you did not pay cash
wages of $1,000 or more in any calendar quarter
in 1985 and 1986.

(4) Certain family employment.

(5) Certain fishing activities

(6) Noncash payments for farmwork or.
household services in a private home that are
included on line 1. Only cash wages to these
workers are taxable.

(7) Value of certain meals and lodging.

(8) Any other exempt service or pay.

For more information, see Circular E.

Line 3.—Enter the total amounts of more than
$7,000 you paid each employee. For example, if
you have 10 employees to whom you paid $8,000
each during the year, enter $80,000 on line 1 and
$10,000 on line 3. The $7,000 wage limitation is
for FUTA purposes only. Do not use the state
wage limitation for this entry.

Line 5—Total taxable wages.—If any part of
these wages 1s exempt from state unemployment
taxes, you must fill out Parts Ill and V. For
example, if you pay wages to corporate officers in
a state that exempts these wages from its
unemployment taxes, you would check the box in
Con page 1 and complete Parts Ill and V.

Line 6.—Enter any wages included on line 5
subject to the unemployment compensation laws
of the states listed. (If in doubt, ask your state
unemployment insurance service.) Multiply the
wages by the appropriate rate. This adjustment
increases the FUTA tax by the amount shown on
line 7, by reducing the credit otherwise allowable
against the FUTA tax for contributions made to
state unemployment funds. (However, the
increase cannot be more than the credit
otherwise allowable.)

Note: The sum of the wages shown on line 6
cannot exceed the total taxable wages shown on
line 5. \f no wages are subject, enter “none” on
line 7.

Part Il.—Tax Due or Refund

Use this part only if you checked “Yes” for both
questions A and B on page 1, and did not check
the box in C. The tax rate of .008 gives you credit
for your payments to your state’s unemployment
fund.

Part IIl.—Tax Due or Refund

Use this part if you do not qualify for Part II
Line 3.—Enter the smaller of (1) Part V,
line11—Total tentative credit, or (2) Part Ill, line
2—5.4% of taxable FUTA wages. This is the
maximum credit allowable for your payments to
the state unemployment fund.

Lines 4 and 5.—Enter the amount from Part |,
line 7 on line 4. Subtract this amount from Part
Ill, line 3. The result on line 5 ts your allowable
credit for payments to the state.

Part IV.—Record of Federal Tax Liability

Complete this part if your total tax (Part Il, line 3
or Part Ill, line 6) is over $100. To figure your
FUTA tax liability for each of the first 3 quarters
‘of 1986, multiply by .008 that part of the first
$7,000 of each employee's annual wages you
paid during the quarter. Enter this amount under
that quarter.

Your liability for the 4th quarter is the total tax
(Part Il, line 3 or Part III, line 6) minus your
liability for the first 3 quarters of the year. The
total liability must equal your total tax. Otherwise,
you may be charged a failure to deposit penalty
figured on your average liability.

Depositing FUTA Tax.— If your liability for any
of the first 3 quarters of 1986 (plus any
undeposited amount of $100 or less from any
earlier quarter) is over $100, deposit it by the last
day of the first month following the close of the
quarter. If it is $100 or less, carry it to the next
quarter; a deposit is not required. If your liability
for the 4th quarter (plus any undeposited amount
from any earlier quarter) is over $100, deposit the
entire amount by February 2, 1987. If itis $100
or less, you can either make a deposit or pay it
with your Form 940 by February 2.

Note: The tota! amount of all deposits must be
shown in Part Il, line 4 or Part Ill, line 7.

If you deposited the correct amounts,
following these rules, the balance due with Form
940 will never be more than $100.

Deposit FUTA tax in an authorized financial
institution or the Federal Reserve Bank for your
area. To avoid a possible penalty, do not mail
deposits directly to IRS. Records of your deposits
will be sent to IRS for crediting to your business
accounts, See /dentifying Your Payments on
page 2.

You must use a Form 8109, Federal Tax
Deposit Coupon, when making each tax deposit.
IRS will send you a book of deposit coupons when
you apply for an employer identification number.
Follow the instructions in the coupon book. If you
don't have coupons, see Circular E.

Taxpayers who willfully claim credit for
deposits not made are subject to fines and other
criminal penalties

Part V.—Computation of Tentative
Credit

Complete this schedule if: (1) You made
payments to the unemployment fund of more
than one state; (2) You did not make all your state
payments by the due date of Form 940; or (3) Any
wages subject to FUTA tax were exempted from
state unemployment taxes. If you have been
assigned an experience rate by your state of 0%
or more, but less than 5.4% for all or part of the
year, use columns 1 through 9. If you have not
been assigned any experience rate by your state,
use columns 1, 2, 3, and 9 only. If you have a rate
of 5.4% or higher, use columns 1, 2, 3, 4,5, and
9 only. If you were granted an experience rate for
only part of the year or the rate was changed
during the year, complete a separate line for each
state experience rate period.

Column 1.—Enter the name of the state(s)
(including Puerto Rico and the Virgin Islands) that
you were required to pay contributions to.
Column 2.—Enter the state reporting number
that was assigned to you when you registered as
an employer with each state.

Column 3.—Enter the taxable payroll on which
you must pay taxes to the unemployment fund of
each state in column 1. If your experience rate is
zero, enter the amount of wages that you would
have had to pay on if the rate had not been granted.
Columns 4 and 5.—Your state experience rate is
the rate at which the state taxes your payroll for
state unemployment purposes. This rate may be
adjusted from time to time based on your
“experience” with the state fund, that is,
unemployment compensation paid to your former
employees and other factors. If you do not know
your rate, contact your state unemployment
insurance service.

Column 8.—Subtract column 7 from column 6. If
Zero or less, enter ‘'0.””

Column 9.—Enter contributions actually paid
into the state fund by the due date of Form 940.
Do not include any special assessments, surtaxes,
surcharges, etc., used by the state to pay interest
‘on unrepaid advances from the Federal
Government.

Line 11.—Add line 10, columns 8 and 9. The
allowable credit for state contributions you make
after the due date for filing Form 940 may not be
more than 90% of the credit that would have
been allowed if you had paid the state
contributions by the due date. For example, if
$1,500 of state contributions was paid on time,
and $1,000 was paid after the due date for filing
Form 940, the total tentative credit on line 11
(assuming no additional credit (column 8)) would
be $2,400 ($1,500 + $900 (90% of $1,000)).
Note: /f you are receiving additional credit
(column 8) because your state experience rate is
less than 5.4%, the additional credit is not subject
to the 90% limitation.


940 Employer’s Annual Federal OMB No. 1545.0028
Form Unemployment (FUTA) Tax Return 1986

Department of the Treasury

Internal Revenue Service > For Paperwork Reduction Act Notice, see page 2.
IName (as distinguished from trade name) Calendar year FF
Iti ,
incorrect,
ie any » Trade name, if any FP
necessary T
change. Address and ZIP code Employer identification number T
L C=)
A Did you pay all required contributions to your state unemployment fund by the due date of Form 940? (See instructions if none required.). . |_| Yes C] No

If you checked the ‘'Yes"’ box, enter amount of contributions paid to your state unemployment fund.
B Are you required to pay contributions to only one state?

if you checked the Yes" box: (1) Enter the name of the state where you are required to pay contributions .
(2) Enter your state reporting number(s) as shown on state unemployment tax return.
If any part of wages subject to FUTA tax is not subject to state unemployment tax, check the box
[EEA Computation of Taxable Wages and Credit Reduction (To be completed by all taxpayers. y
1 Total payments (including exempt payments) during the calendar year for services of employees. .. fd
Amount paid

2 Exempt payments. (Explain each exemption shown, attaching additional sheets if

necessary.) >

3 Payments for services of more than $7,000. Enter only the excess over the first $7,000
paid to individual employees not mcluding exempt mounts shown an line 2. Do not use | 3
the state wage limitation rn :

4 Total exempt payments (add lines 2 and 3) .
5 Total taxable wages (subtract line 4 from line 1). (If any part Is exempt from st state e contributions, see instructions » 5

6 Additional tax resulting from credit reduction for unrepaid advances to the states listed (by two-letter Postal Service abbreviations). Enter the wages included on
line 5 above for each state and multiply by the rate shown. (See the instructions.)

fa) Ik _ x.012=_ () OH_ x.0ll= . @ Wooo XOlle
(b) LAL (d) PAL x.012=

7 Total credit reduction (add resulting amounts from lines = 62) through Ste) a and enter here and in Part Ii, line 2 or
Partill, ine4).. ee Se a 2a

[ Part 11 | Tax Due or Refund (Complete ifyou ck checked the “Yes” boxes in both th questions A and B and did not check the box in C, above.)

1 FUTAtax. Multiply the wages in Partl, line 5, by.008andenterhere . 2 . 2 2 1 1 ew ee we LE

2 Enter amount from Part |, line 7
3. Total FUTA tax (add lines 1 and 2) . .
4 Minus: Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records)

5 Balance due (subtract line 4 from line 3). This should be $100 or less. PaytoIRS ad
6 Rh Tox bac or Refund line 4). Check ifitis to be:__) Applied to next return, or ]_ Refunded ._. >

alalalwlr

Tax Due or Refund (Complete if you checked the “No” box in either question A or B or you checked the box in C, above. Also complete Part V.)

1 Gross FUTA tax. Multiply the wages in Part |, line 5, by.062.. . re

2 Maximum credit. Multiply the wages in Part I, line5,by.054. . . 2. . . . . [2 / ] YY) ]]
YY
3 Enterthe smaller of the amount in Part V, line 11, orParti,fine2. . . 2 . . . L3 Mii 7];

4 Enter amount from Part |, line 7 4
5 Credit allowable (subtract line 4 from line 3) (ifzeroo or less, enter 0 )). 5
6 Total FUTA tax (subtract line 5 from line 1). 6
7 Minus: Total FUTA tax deposited for the year, including any overpayment applied f from a prior year (irom your records) 7
8 Balance due (subtract line 7 from line 6). This should be $100 or less. PaytoIRS . . > 18
9 _ Overpayment (subtract line 6 from line 7). Check if itis to be: [_] Applied to next return, or orl] Refunded.» > | 9
Record of Quarterly Federal Tax Liability for Unemployment Tax (Do not include state liability.)
Quarter First Second Third Fourth Total for Year

Liability for quarter

If you will not have to file returns in the future, write “Final” here (see general instruction “Who Must File”) and sign the return. >

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and
complete, and that no part of any payment made to a state unemployment fund clamed as a credit was or is to be deducted from the payments to employees.

Signature > Title (Owner, etc.) Date >

Form 9.40 (1986)


Form 940 (1986) Page 2
Computation of Tentative Credit (Complete if you checked the “No” box in either question A or B or you checked the box in C, on page 1—see instructions.)
Name [State reporting number(s) State ex] Contributions if | Contributions — | Additionalcredit | Contributions
of | as shown on employer's | (as aaneaipniove act) State experience rate period —_| pentence|rate had been 5.4% payableat experience |(col. 6 minuscol.7) | actually paid to
state | state contribution returns 4 rate | (col. 3x.054) | rate (col. 3xcol. 5) |IfOorless, enter0. state
1 2 3 From— To— 5 6 7 8 9
10 Totals. =
11 Total tentative credit (add line 10, columns 8 and 9—see instructions for limitations) =

Paperwork Reduction Act Notice.—We ask for this
information to carry out the Internal Revenue
laws of the United States. We need it to ensure
that taxpayers are complying with these laws and
to allow us to figure and collect the right amount
of tax. You are required to give us this
information

Changes You Should Note for 1986.—Public Law
99.272 reinstated the exemption from FUTA tax for
services performed by certain alien farmworkers,
full-time students employed by organized camps,
and fishing boat crew members.The Tax Reform Act
of 1986 reinstated the exemption for amounts
received under educational assistance programs
(aiso increasing the maximum exclusion to $5,250)
and received under group legal services plans. See
Circular E, Employers’ Tax Guide, for details.

General Instructions

Purpose of Form.—Use this form for your annual
FUTA tax report. Only the employer pays this tax.

Who Must File

Household Employers.—You do not have to file this
form unless you paid cash wages of $1,000 or more
in any calendar quarter in 1985 or 1986 for
household work in a private home, local college club,
ora local chapter of a college fraternity or sorority.
Note: See Publication 503, Child and Dependent
Care Credit, and Employment Taxes for Household
Employers, for more information.

In General.—You must file this form if you were
other than a household or agricultural employer
during 1985 or 1986, and you (a) paid wages of
$1,500 or more in any calendar quarter, or (b) had
one or more employees for some part of a day in any
20 different weeks. Count all regular, temporary,
and part-time employees. A partnership should not
count its partners. If there is a change in ownership
or other transfer of business during the year, each
employer who meets test (a) or (b) above must file.
Neither should report wages paid by the other.
Organizations described in section 501(c)(3) of the
Internal Revenue Code do not have to file
Agricultural Employers.—You must file Form 940
if either of the following applies to you:

(1) You paid cash wages of $20,000 or more to.
farmworkers during any calendar quarter in 1985 or
1986.

(2) You employed 10 or more farmworkers during
some part of a day (whether or not at the same time)
for at least one day during any 20 different weeks in
1985 or 1986. Count aliens admitted to the United
States on a temporary basis to perform farmwork to
determine if you meet either of the above tests.
However, wages paid to these aliens are not subject
to FUTA tax before 1993.

Completing Form 940
Employers Who Are Not Required To Deposit
FUTA Tax.—If your total FUTA tax for 1986 is not
more than $100, you do not have to deposit the tax.
Make your FUTA tax payment when you file Form
940. If you do not have to deposit FUTA tax and you :
(a) made all required payments to your state
unemployment fund by the due date of
Form 940,
(b) are required to make payments to the
unemployment fund of only one state; and

(c) paid wages subject to Federal
unemployment tax that are also subject to
state unemployment tax,

complete Parts | and Il. Otherwise, complete Parts
1, Ill, and V.

Employers Who Are Required To Deposit FUTA
Tax.—If you meet tests (a), (b), and (c) above,
complete Parts |, Il, and IV. Otherwise, complete
Parts |, Ill, IV, and V.

{f You Are Not Liable for FUTA Tax.—If you receive
Form 940 and are not liable for FUTA tax for 1986,
write ‘Not Liable" across the front and return it to
IRS. If you will not have to file returns after this, write
“Final” on the line above the signature line and sign
the return

Due Date.—Form 940 for 1986 is due by February
2, 1987. However, if you made timely deposits in full
Bayment of the tax due, your due date is February

Where To File.—
It your principal
business, office or
agency isiocated in:

File with the
Internal Revenue
Service Center at:

Alabama, Flonda, Georgia, Mississipp,
South Carolina

New Jersey, New York City and counties
of Nassau, Rockland, Suffolk, and
Westchester

Atlanta, GA 31101

Holtsville, NY 00501

New York (all other counties), Connecticut,
Maine, Massachusetts, Minnesota, New
Hampsture, Rhode Island, Vermont

‘Andover, MA 05501

Minors. lowa, Missoun, Wisconsin

Delaware, District of Columbia
Maryland, Pennsylvania, Puerto Rico,
Virgin islands

Kentucky, Michigan, Ohio,
West Virginia

Kansas City, MO 64999,

Philadelphia, PA 19255

Cincinnati, OH 45999

Kansas, Louisiana, New Mexico,
Oklahoma, Texas

‘Alaska, Arizona, California (counties of
Alpine, Amador. Butte, Calaveras, Colusa,
Contra Costa, Del Norte, El Dorado, Glenn.
Humboldt, Lake, Lassen, Marin, Mendocino,
Modoc, Napa, Nevada, Placer, Plumas,
Sacramento, San Joaquin, Shasta, Sierra,
Siskiyou, Solano, Sonoma, Sutter. Tehama,
Trinity, Yolo, and Yuba), Colorado, Idaho,
Montana, Nebraska, Nevada, North Daksta,
Oregon, South Dakota, Utah, Washington,
Wyoming.

Austin, TX 73301

Ogden, UT 84201

California (all other counties), Hawai Fresno, CA 93888

‘Arkansas, Indiana, North Carolina,

Tennessee, Virginia Memphis, TN 37501

Ifyou have nolegal residence or principal place of business in any
IRS dst, ile wth te Internal Revenve Service Center.
Philadelphia, PA'19255

Employer's Name, Address, and Identification
Number.—Use the preaddressed Form 940 mailed
to you. If you must use a nonpreaddressed form,
type or print your name, trade name, address, and
employer identification number on it.

See Publication 583, Information for Business
Taxpayers, for details on how to make tax deposits,
file a return, etc., if these are due before you receive
your number.

Identifying Your Payments.—On balance due
payments made to IRS (Part Il, ine 5 and Part Ill,
line 8) and Federal tax deposit payments, write your
employer identification number, “Form 940," and
tax period to which the payment applies on your
check or money order. This will help ensure proper
crediting of your account.

Penalties and Interest.—Avoid penalties and
interest by making tax deposits when due and filing a
correct return and paying the proper amount of tax
when due. The law provides penalties for late
deposits and late filing unless you show reasonable
cause for the delay. If you file late, attach an
explanation to the return. The law also provides a
penalty of 25% of the overstatement if, without
reasonable cause, you overstate the amount you
deposited.

There are also penalties for willful failure to pay
tax, keep records, make returns, and for filing false
or fraudulent returns.

Credit for Contributions Paid Into State
Funds.—You can claim credit for amounts you pay
into a certified state (including Puerto Rico and the
Virgin Islands) unemployment fund by the due date
of Form 940.

Note: Be sure to enter your state reporting number
where required on Form 940. This number is needed
for IRS to verify your state contributions.

“Contributions” are payments that state law
requires you to make to an unemployment fund
because you are an employer. These payments are
“contributions” only to the extent that they are not
deducted or deductible from the employees’ pay.

You may not take credit for voluntary payments or
for penalties or interest payments to a state. Nor
may you take credit for any special assessment,
surtax, surcharge, etc., by the state for paying
interest on unrepaid Title XII loans from the Federal
Government:

If you have been granted an experience rate lower
than 5.4% (.054) by a state for the whole or part of
the year, you are entitled to an additional credit. This,
credit 1s equal to the difference between actual
payments and the amount you would have been
required to pay at 5.4%.

The total credit allowable may not be more than
5.4% of taxable FUTA wages

Special Credit for Successor Employers.—If you
are claiming special credit as a successor employer,
see Code section 3302(e) or Circular E, for the
conditions you must meet.

Amended Returns.—if you are amending a
previously filed return, complete a new Form 940,
using the amounts that should have been used on
the original return, and sign the return, Attach a
statement explaining why you are filing an amended
return, Be sure to use a Form 940 for the year you
are amending. Write "AMENDED RETURN at the
top of the form and file it with the Internal Revenue
Service Center where you filed the original return.

Specific Instructions

You must answer questions A and B (check the
box in C only it it applies), complete Part I, and
sign the return.

Note: /f you have been assigned a zero percent
experience rate by your state, so that there are no
required contributions to the state unemployment
fund, check the “Yes” box in question A and write
“0% rate" on the dollar amount line.

Use Part Il only if you checked the “Yes” boxes in
questions A and B and did not check the box in C.
Otherwise, skip Part Il and complete Parts Ill and V.

Complete Part IV if your total tax for the yearis
more than $100.

(instructions continued on page 4.)


com 940 Employer’s Annual Federal |_ome no. 1545-0028 _
Department ofthe Treasury Unemployment (FUTA) Tax Return 198 6

Internal Revenue Service > For Paperwork Reduction Act Notice, see page 2.
Employer identification number

EMPLOYER'S
COPY

A Did you pay all required contributions to your state unemployment fund by the due date of Form 940? (See instructions if none required.). . (_] Yes |] No
If you checked the ‘Yes’ box, enter amount of contributions paid to your state unemployment fund. a

B_ Are you required to pay contributions to only one state? So
If you checked the “Yes” box: (1) Enter the name of the state where you are required to pay contributions... . .
(2) Enter your state reporting number(s) as shown on state unemployment tax return. >
C_ If any part of wages subject to FUTA tax 's not subject to state unemployment tax, check the box
[Part || Computation of Taxable Wages and Credit Reduction (To be completed by all taxpayers. = ;
T

1 Total payments (including exempt payments) during the calendar year for services of employees : .. [1
Amount paid

Uy

2 Exempt payments. (Explain each exemption shown, attaching additional sheets if
necessary.) P_

3 Payments for services of more than $7,000. Enter only the excess over the first $7,000
paid to individual employees not including exempt amounts shown on line 2. Do not use 3
the state wage limitation. oe oo

4 Total exempt payments (add lines 2 and 3)

Total taxable wages (subtract line 4 from line 1). (If any part is exempt from state e contributions, see instructions. <)>

6 Additional tax resulting from credit reduction for unrepaid advances to the states listed (by two-letter Postal Service abbreviations). Enter the wages included on
line 5 above for each state and multiply by the rate shown. (See the instructions.)

wa

fa) Ib x.0ll= fe) Woe KOS oe
() LA

7 Total credit reduction (add resulting amounts from lines 6(a) through Ste) a and enter here and in Part ll, line 2 or
Partlli,line4). sme 17 |

| Part 11 | Tax Due or Refund (Complete ityouct checked the “Yes” boxes in both questions Aand B and did not check the box in C, above.)

1 FUTAtax. Multiply the wages in Part, line 5, by.00Bandenterhere . . 2 2 2 7 ee ee ee LD

2 > Enter amount from Part |, line 7

3. Total FUTA tax (add lines 1 and 2)

4. Minus: Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records)
5 Balance due (subtract line 4 from line 3). This should be $100 or less. PaytoIRS . a

6 _ Overpayment (subtract line 3 from line 4), Check ifit is tobe: [_] Applied tonext return, or 1 Refunded _ > | 6
Fart il Tax Due or Refund (Complete if you checked the “No” box in either question A or B or you checked the box in C, above. Also complete Part V.)

wi] alone

1 Gross FUTA tax. Multiply the wages in Part, line5,by.062.. . . 2... we ee ee LE

2 Maximum credit. Multiply the wages in Partl, line5,by.054. . . . . . . . . [2 YI) Ly) 7 q
3. Enter the smaller of the amount in Part V, line 11, orPartilline2.. . . 2... U3 MMMM 7 I

4 Enter amount from Part |, line 7 4
5 Credit allowable (subtract line 4 from line 3) (ifzeroor les, enter0,) . 5
6 Total FUTA tax (subtract line 5 from line 1). 6
7 Minus: Total FUTA tax deposited for the year, including any overpayment applied tr from a prior year (irom your records) 7
8 Balance due (subtract line 7 from line 6). This should be $100 or less. PaytoIRS . . . > 18
9 Overpayment (subtract line 6 from line 7). Check if itis to be: |_] Applied tonext return, or L] Refunded. > | 9
Record of Quarterly Federal Tax Liability for Unemployment Tax (Do not include state liability.)
Quarter First Second Third Fourth Total for Year

Liability for quarter
if you will not have to file returns in the future, write “Final” here (see general instruction “Who Must File”) and sign the return. >

Keep This Copy for Your Records—You must keep this copy and a copy of For More Information—See Circular E and Publication 539, Employment
each related schedule or statement for a period of 4 years after the date the tax Taxes, for more information, Household employers should see Publication 503.
is due or paid, whichever is later. These copies must be available for inspection

by the Internal Revenue Service.