Part 1: Select ONLY one process.

Part 2: Enter the corrections for this year. If any line does not apply, leave it blank.

Enter the date you discovered errors:

Next ©

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 20336X Form 945-X (1-2009)

945-X:

(January 2009) OMB No. 1545-1430

Adjusted Annual Return of Withheld Federal Income Tax or Claim for Refund

Department of the Treasury — Internal Revenue Service

Use this form to correct errors made on Form 945, Annual Return of Withheld Federal Income Tax, for one year only. Please type 

or print within the boxes. Do not attach this form to Form 945.

Return You Are Correcting ...

Form

Enter the calendar year of the return

you are correcting:

/ /

(MM / DD / YYYY)

(YYYY)

1.

2.

Employer identification number

(EIN)

Name (not your trade name)

Trade name (if any)

Address Number Street Suite or room number

City State ZIP code

—

Adjusted return of withheld federal income tax. Check this box if you underreported amounts. Also check this box if you

overreported amounts and you would like to use the adjustment process to correct the errors. You must check this box if you are

correcting both underreported and overreported amounts on this form. The amount shown on line 5, if less than 0, may only be applied

as a credit to your Form 945 for the tax period in which you are filing this form.

Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement

of the amount shown on line 5. Do not check this box if you are correcting ANY underreported amounts on this form.

You MUST complete both pages. Read the instructions before you complete this form.

3.

4.

Column 1 Column 2

Federal income tax withheld

(from line 1 of Form 945) 

Backup withholding 

(from line 2 of Form 945) —

—

=

=

Total corrected

amount 

(for ALL payees)

Amount originally

reported or as

previously corrected

(for ALL payees)

=

Column 3

Difference

(If this amount is a

negative number,

use a minus sign.)

— . .

.

.

. .

If line 5 is more than 0, this is the amount you owe. Pay this amount when you file this return. For information on how to pay,

see Amount You Owe in the instructions for line 5.

If line 5 is less than 0:

● If you checked line 1, this is the amount you want applied as a credit to your Form 945 for the tax period in which you are

filing this form.

● If you checked line 2, this is the amount you want refunded or abated.

5. Total. Combine the amounts in lines 3 and 4 of Column 3 .
6. Check here if any corrections you entered on a line include both underreported and overreported amounts.

Explain both your underreported and overreported amounts on line 7.

Form 945-X (1-2009)

7. You must give us a detailed explanation of how you determined your corrections. See the instructions.

Preparer’s name

Firm’s name (or yours if

self-employed)

Address

EIN

Phone

ZIP code

Check if you are self-employed 

City State

( ) –

Page 2

Part 3: Explain your corrections for this year.

Part 4: Sign here. You must complete both pages of this form and sign it.

Under penalties of perjury, I declare that I have filed an original Form 945 and that I have examined this adjusted return or claim and any schedules or

statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer)

is based on all information of which preparer has any knowledge.

Sign your

name here

Print your

name here

Date / / Best daytime phone ( ) –

Print your

title here

Name (not your trade name) Employer identification number (EIN) Calendar Year (YYYY)

Preparer’s signature

Paid preparer’s use only

Preparer’s

SSN/PTIN

Date / /