Form 945

Department of the Treasury 

Internal Revenue Service 

Annual Return of Withheld Federal Income Tax

▶ For withholding reported on Forms 1099 and W-2G.

▶ See separate instructions. For more information on income tax withholding, see Pub. 15 (Circ. E) and Pub. 15-A.

Information about Form 945 and its separate instructions is at www.irs.gov/form945.

OMB No. 1545-1430

2012

Type 

or 

Print 

Name (as distinguished from trade name)

Trade name, if any

Address (number and street)

Calendar year

Employer identification number (EIN)

City, state, and ZIP code

If address is 

different 

from prior 

return, check

here. ▶

A If you do not have to file returns in the future, check here ▶ and enter date final payments made. ▶

1 Federal income tax withheld from pensions, annuities, IRAs, gambling winnings, etc. . . . . . 1

2 Backup withholding . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Total taxes. If $2,500 or more, this must equal line 7M below or line M of Form 945-A . . . . 3

4 Total deposits for 2012, including overpayment applied from a prior year and overpayment applied

from Form 945-X . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Balance due. If line 3 is more than line 4, enter the difference and see the separate instructions . 5

6 Overpayment. If line 4 is more than line 3, enter the difference ▶ $ 

Check one: Apply to next return. Send a refund.

• All filers: If line 3 is less than $2,500, do not complete line 7 or Form 945-A.

• Semiweekly schedule depositors: Complete Form 945-A and check here . . . . . . . . . . . . . . . . ▶

• Monthly schedule depositors: Complete line 7, entries A through M, and check here . . . . . . . . . . . ▶

7 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)

Tax liability for month 

A January . . .

B February . .

C March . . .

D April . . . .

E May . . . .

Tax liability for month 

F June . . . . .

G July . . . . .

H August . . . .

I September . . .

J October . . . .

Tax liability for month 

K November . .

L December . .

M Total liability for 

year (add lines A

through L ) . .

ThirdParty 

Designee

Do you want to allow another person to discuss this return with the IRS (see the instructions)? Yes. Complete the following. No.

Designee’s 

name ▶

Phone 

no. ▶

Personal identification 

number (PIN) ▶

Sign 

Here

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Signature ▶

Print Your 

Name and Title ▶ Date ▶

Paid 

Preparer 

Use Only

Print/Type preparer’s name Preparer’s signature Date Check if 

self-employed 

PTIN

Firm’s name ▶

Firm’s address ▶

Firm's EIN ▶

Phone no. 

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 14584B Form 945 (2012)
Form 945-V, 

Payment Voucher

Purpose of Form

Complete Form 945-V, Payment Voucher, if you are 

making a payment with Form 945, Annual Return of 

Withheld Federal Income Tax. We will use the completed 

voucher to credit your payment more promptly and 

accurately, and to improve our service to you.

Making Payments With Form 945

To avoid a penalty, make your payment with your 2012 

Form 945 only if:

• Your total taxes for the year (Form 945, line 3) are less 

than $2,500 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 make deposits by electronic funds 

transfer. See section 11 of Pub. 15 (Circular E) for deposit 

instructions. Do not use Form 945-V to make federal tax 

deposits.

Caution. Use Form 945-V when making any payment with 

Form 945. However, if you pay an amount with Form 945 

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

Box 1—Employer identification number (EIN). If you do 

not have an EIN, you may apply for one online. Go to 

IRS.gov and click on the Apply for an EIN Online link 

under “Tools.” You may also apply for an EIN by calling 

1-800-829-4933, or you can fax or mail Form SS-4, 

Application for Employer Identification Number. If you 

have not received your EIN by the due date of Form 945, 

write "Applied For" and the date you applied in this entry 

space.

Box 2—Amount paid. Enter the amount paid with Form 

945.

Box 3—Name and address. Enter your name and

address as shown on Form 945.

• Enclose your check or money order made payable to 

the “United States Treasury.” Be sure to enter your EIN, 

“Form 945,” and “2012” on your check or money order. 

Do not send cash. Do not staple Form 945-V or your 

payment to the return (or to each other).

• Detach Form 945-V and send it with your payment and 

Form 945 to the address provided in the Instructions for 

Form 945.

Note. You must also complete the entity information

above line A on Form 945.

✁ ▼ Detach Here and Mail With Your Payment and Form 945. ▼

✃

Form 945-V

Department of the Treasury 

Internal Revenue Service 

Payment Voucher

▶ Do not attach this voucher or your payment to Form 945.

OMB No. 1545-1430

2012

1 Enter your employer identification number (EIN). 2

Enter the amount of your payment . . ▶

Make your check or money order payable to “United States Treasury”

Dollars Cents

3 Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city, state, and ZIP code.