OMB No. 1545-0028 Employer’s Annual Federal

Unemployment (FUTA) Tax Return Form 940

Department of the Treasury

Internal Revenue Service © For Paperwork Reduction Act Notice, see separate instructions.

T

FF

FD

FP

I

T

Yes No

If you will not have to file returns in the future, check here, complete, and sign the return ©

Computation of Taxable Wages

1

Total payments (including payments shown on lines 2 and 3) during the calendar year for

services of employees

1

Amount paid Exempt payments. (Explain all exempt payments, attaching additional

sheets if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the

first $7,000 paid to each employee. Do not include any exempt payments

from line 2. The $7,000 amount is the Federal wage base. Your state

wage base may be different. Do not use the state wage limitation

3

3

4 Total exempt payments (add lines 2 and 3) 4

5 Total taxable wages (subtract line 4 from line 1) © 5

Form 940 (1996)

Part I

If this is an Amended Return, check here ©

A Are you required to pay unemployment contributions to only one state? (If “No,” skip questions B and C.)

B

C

Be sure to complete both sides of this return and sign in the space provided on the back.

Name (as distinguished from trade name) Calendar year

Trade name, if any

Address and ZIP code Employer identification number

Did you pay all state unemployment contributions by January 31, 1997? (If a 0% experience rate is granted,

check “Yes.”) (If “No,” skip question C.)

Were all wages that were taxable for FUTA tax also taxable for your state’s unemployment tax?

If you answered “No” to any of these questions, you must file Form 940. If you answered “Yes” to all the

questions, you may file Form 940-EZ, which is a simplified version of Form 940. (Successor employers see

Special Credit for Successor Employers.) You can get Form 940-EZ by calling 1-800-TAX-FORM

(1-800-829-3676).

Yes No

Yes No

Cat. No. 11234O

Form 940-V

Department of the Treasury

Internal Revenue Service

Form 940 Payment Voucher

Enter the amount of the payment you are making Enter the first four letters of your last

name (business name if partnership or

corporation)

1 2

4 Enter your business name (individual name for sole proprietors)

DETACH HERE

OMB No. 1545-0028

© $ .

Use this voucher when making a payment with your return.

3 Enter your employer identification number

Enter your address

Enter your city, state, and ZIP code

Complete boxes 1, 2, 3, and 4. Do not send cash and do not staple your payment to this voucher. Make your check or money order payable to the

Internal Revenue Service. Be sure to enter your employer identification number, “Form 940,” and “1996” on your payment.

Instructions for Box 2

96

96

—Individuals (sole proprietors, trusts, and estates)—

Enter the first four letters of your last name.

—Corporations and partnerships—Enter the first four

characters of your business name (omit “The” if

followed by more than one word).

(98)
Tax Due or Refund

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

2 Maximum credit. Multiply the wages in Part l, line 5, by .054 2

3

Total FUTA tax (subtract line 6 from line 1)

Total FUTA tax deposited for the year, including any overpayment applied from a prior year

5

Balance due (subtract line 8 from line 7). This should be $100 or less. Pay to the Internal Revenue

Service. See page 3 of the Instructions for Form 940 for details ©

6

7

Overpayment (subtract line 7 from line 8). Check if it is to be: Applied to next return,

or Refunded ©

7

Record of Quarterly Federal Unemployment Tax Liability ( Do not include state liability. )

Quarter First Second Third Fourth Total for year

Liability for quarter

(a)

Name

of

state

(i)

Contributions

actually paid

to state

(h)

Additional credit

(col. (f) minus col.(g)).

If 0 or less, enter -0-.

(g)

Contributions

payable at experience

rate (col. (c) x col. (e))

(f)

Contributions if

rate had been 5.4%

(col. (c) x .054)

(e)

State experience

rate

(b)

State reporting number(s)

as shown on employer’s

state contribution returns

(c)

Taxable payroll

(as defined in state act)

(d)

State experience rate period

From To

Totals ©

Total tentative credit (add line 3a, columns (h) and (i) only—see instructions for limitations on late payments) ©

Form 940 (1996) Page 2

Part III

Computation of tentative credit (Note: All taxpayers must complete the applicable columns.)

3a

3b

4

9

8

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, and that no part of any payment made to a state unemployment fund claimed as a credit was or is to be deducted from the payments to employees.

Signature © Title (Owner, etc.) © Date ©

8

9

Credit: Enter the smaller of the amount in Part II, line 2 or line 3b

10

10

Part II

6
OMB No. 1545-0028 Employer’s Annual Federal

Unemployment (FUTA) Tax Return Form 940

Department of the Treasury

Internal Revenue Service © For Paperwork Reduction Act Notice, see separate instructions.

Yes No

If you will not have to file returns in the future, check here, complete, and sign the return ©

Computation of Taxable Wages

1

Total payments (including payments shown on lines 2 and 3) during the calendar year for

services of employees

1

Amount paid Exempt payments. (Explain all exempt payments, attaching additional

sheets if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the

first $7,000 paid to each employee. Do not include any exempt payments

from line 2. The $7,000 amount is the Federal wage base. Your state

wage base may be different. Do not use the state wage limitation

3

3

4 Total exempt payments (add lines 2 and 3) 4

5 5

Part I

If this is an Amended Return, check here ©

A Are you required to pay unemployment contributions to only one state? (If “No,” skip questions B and C.)

B

C Were all wages that were taxable for FUTA tax also taxable for your state’s unemployment tax?

If you answered “No” to any of these questions, you must file Form 940. If you answered “Yes” to all the

questions, you may file Form 940-EZ, which is a simplified version of Form 940. (Successor employers see

Special Credit for Successor Employers.) You can get Form 940-EZ by calling 1-800-TAX-FORM

(1-800-829-3676).

Yes No

Yes No

Total taxable wages (subtract line 4 from line 1) ©

Form 940 (1996)

Did you pay all state unemployment contributions by January 31, 1997? (If a 0% experience rate is granted,

check “Yes.”) (If “No,” skip question C.)

96
Computation of tentative credit (Note: All taxpayers must complete the applicable columns.)

Note: You must keep this copy and a copy of each related schedule or statement for 4 years after the date the tax is due or paid, whichever

is later. These copies must be available for inspection by the IRS.

Tax Due or Refund

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

2 Maximum credit. Multiply the wages in Part l, line 5, by .054 2

3

Total FUTA tax (subtract line 6 from line 1)

Total FUTA tax deposited for the year, including any overpayment applied from a prior year

5

6

Balance due (subtract line 8 from line 7). This should be $100 or less. Pay to the Internal Revenue

Service. See page 3 of the Instructions for Form 940 for details ©

6

7

Overpayment (subtract line 7 from line 8). Check if it is to be: Applied to next return,

or Refunded ©

7

Record of Quarterly Federal Unemployment Tax Liability ( Do not include state liability. )

Quarter First Second Third Fourth Total for year

Liability for quarter

(a)

Name

of

state

(i)

Contributions

actually paid

to state

(h)

Additional credit

(col. (f) minus col.(g)).

If 0 or less, enter -0-.

(g)

Contributions

payable at experience

rate (col. (c) x col. (e))

(f)

Contributions if

rate had been 5.4%

(col. (c) x .054)

(e)

State experience

rate

(b)

State reporting number(s)

as shown on employer’s

state contribution returns

(c)

Taxable payroll

(as defined in state act)

(d)

State experience rate period

From To

Totals ©

Total tentative credit (add line 3a, columns (h) and (i) only—see instructions for limitations on late payments) ©

Form 940 (1996) Page 4

Part III

3a

3b

4

9

8

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, and that no part of any payment made to a state unemployment fund claimed as a credit was or is to be deducted from the payments to employees.

Signature © Title (Owner, etc.) © Date ©

8

9

10

10

Part II

Credit: Enter the smaller of the amount in Part II, line 2 or line 3b