Page 4

GENERAL INSTRUCTIONS

The instructions below tell you details for preparing and filing Form
940, Additional instructions are contained in Circular E, which has
been furnished to employers in connection with (a) Income tax with-
holding, (4) taxes under the Federal Insurance Contributions Act, and
(c) the tax under the Federal Unemployment Tax Act. Circular E may
be obtained from your District Director of Internal Revenue upon request.

Employers should refer to Circular E for information as to the em-
ployers who are liable for filing a return on Form 940, the types of pay-
ments defined by law as wages, and the kind of services covered by the
Federal Unemployment Tax Act.

Purpose of Form 940,—This form is provided for the annual reporting
of the tax under the Federal Unemployment Tax Act.

Who must file—Every employer who had 4 or more employees on at
least 1 day of each of 20 calendar weeks in a calendar year must file a
return on Form 940 for such year. In case of a change of ownership or
other transfer of the business during the year, each employer who had 4
or more employees on at least 1 day of each of 20 calendar weeks in the
calendar year must file a return on Form 940, but neither should report
wages paid by the other, however.

If a statutory merger or consolidation occurs during the calendar year,
the obligation of the continuing corporation to make a return on Form
940, and the reporting of wages and credits on such return, are the same
as if the continuing corporation and the dissolved corporation or corpora-
tions constituted one person during the calendar year.

If you receive a preaddressed form and are not liable for Federal un-
employment tax for 1965 write “not liable” across face of return and re-
turn to your District Director.

After you have once filed a return on Form 940, you will receive a pre-
addressed form near the close of each calendar year. If the form should
fail to reach you, request a Form 940 from your District Director so that
you can make your return on time.

Due date of return—The return on Form 940 is due on or before
January 31 with respect to the preceding calendar year unless the em-
ployer obtains from his District Director an extension of time within
which to file the return,

Unless already shown on the preaddressed form received, enter in the
spaces at the right of the employer's name the calendar year for which
the return is filed.

Where to file——The original of this form is to be sent to the District
Director of Internal Revenue for the district in which the employer's
principal place of business or principal office or agency is located, or, if
the employer's principal place of business or principal office or agency
is not in the United States, to the Director of International Operations,
Internal Revenue Service, Washington, D.C., 20225. Employers whose
principal place of business is in Puerto Rico should file with the Director
of International Operations, U.S. Internal Revenue Service, 1105 Fernan-
dez Juncos Avenue, Santurce, Puerto Rico, 00907.

Payment of tax.—The total tax due must be paid in full with the return.

Employer's name, address, and identification number.—Preaddressed
Forms 940 should be used in filing returns. If the preaddressed form
is lost, a new one should be requested. If necessary to use a form not
preaddressed, type or print in the address block the employer's correct
name and address, and enter the employer's identification number in the

1.8. GOVERNMENT PRINTING OFFICE

space at the right of the address block. Do not use the identification
number assigned to a prior owner.

Penalties and interest—Avoid penalties and interest by filing a correct
return on time, and by paying the proper amount of tax with the return.
‘The law provides a penalty for late filing unless reasonable cause is
shown for the delay. If you are late in filing a return, send a full
explanation in writing with your return.

Penalties also are imposed by law for willful failure to pay tax, keep
records, make returns, or for false or fraudulent returns.

Credit for contributions paid into State funds.—In general, an em-
ployer may credit against the tax the amount of required contributions
paid by him with respect to the calendar year under all State laws which
have been duly approved: Provided, That no credit will be allowable for
contributions under a State law if such State is not duly certified for the
calendar year. The term “contributions” means payments required by a
State law to be made into an unemployment fund by any person on ac-
count of having individuals in his employ, to the extent that such
payments ate made by him without being deducted or deductible from
the remuneration of individuals in his employ. Contributions may be
credited against the tax whether or not they are paid with respect to
“employment.” Do not take credit, however, for voluntary contributions
or for penalty or interest paid to a State.

To be allowable as credit against the tax, contributions must have ac-
tually been paid into a State unemployment fund on or before the due
date of this return or the due date as extended; except that contributions
paid after the due date or the due date as extended, may be credited in
an amount not to exceed 90 percent of the amount which would have
been allowable as credit on account of such contributions had they been
paid on or before such due date.

An employer who has been granted an “experience” rate lower than
2.7 percent by a State for the whole, or part, of the year may be entitled
to an additional credit against the tax under Section 3302(b) of the
Federal Unemployment Tax Act. If the provisions of the State law
under which a taxpayer has been granted a reduced rate are not certified,
or ate only pattially certified, the amount of additional credit claimed
on this return may be disallowed in whole or in part.

Under Section 3302(e) a special credit is provided if an employer dur-
ing any calendar year acquires substantially all the property used in the
trade or business (or in a separate unit of a trade or business) of another
person who is not an “employer” (of 4 or more employees on at least
1 day of each of 20 calendar weeks in that year), and immediately after
the acquisition the successor employs in his trade or business one or more
individuals who immediately prior to the acquisition were employed in
the trade or business of the predecessor. ‘his special credit is not allow-
able to any successor employer whose predecessor also is an “employer,”
nor is it allowable to a corporation acquiring the trade or business of
another corporation in a statutory merger or consolidation. The amount
of the special credit is based on the amount of remuneration, subject to
the unemployment compensation law of a State, paid by the predecessor
to those employees who were employed by the predecessor immediately
before the transfer of the trade or business (or separate unit thereof) and
who also were employed by the successor immediately after the transfer.

The total credit allowable under Section 3302 may not exceed 2.7
percent of such wages.

(See also the instructions on the back of copy for District Director)

16—78905-1

Schedule B—COMPUTATION OF TAXABLE WAGES
(See Schedule B instructions on back of copy for District Director)

1. Total remuneration (including exempt remuneration) PAID during the calendar year for services of

employees. .... +. +eeee eee e eee .

Exempt remuneration:
LIST EACH TYPE OF EXEMPTION

Approximate number of

‘employees involved Amount paid

2. Remuneration in excess of $3,000. (Enter only the excess
over the first $3,000 paid to individual employees)

3. All other exemptions (Explain each exemption shown, at-
taching additional sheet if necessary):

4, Total exempt remuneration. .... 400-200. seee terre eee

XXXKXXXX

xXXXXXXX

5. Total taxable wages (line 1 minus line 4). Enter this amount in Item 15 on other side.........44

ePo

$

16—78065-1


FORM 940 EMPLOYER'S ANNUAL FEDERAL UNEMPLOYMENT TAX RETURN—1965

U.S. Treasury Department — Internal Revenue Service
Schedule A— COMPUTATION OF CREDIT AGAINST FEDERAL UNEMPLOYMENT TAX

State reporting number Experience rate period Contributions had Contributions payable ‘Additional Contributions
Name of sts | ay shown an employers rol (4) Experience | rate been 2.7% at exserince rate retlt actualy paid
State contsibulon returns in State ac) om; Tom ate | (eal. 3 x 2796) (col 3 X eo. 8) (Gol. 6 minus col 7) to Slate
@ (2) @) 6) © (0) (8) 49)

TOTALS. . XXX

10. Total tentative credit (Column 8 plus column 9).. ..
11. Enter here 2.7% of amount of wages in Item 15 below.
12. Item 10 or 11 whichever is smaller
13. Amount, if any, of wages in Item 15 attributable to the following States:
a, Alaska... .

b New Jersey

. West Virginia. .

Total (add amounts from lines a through c)

14. Credit allowable (Item 12 less Item 13). Enter here and in Item 17.
EMPLOYERS—DO NOT USE THIS SPACE— CONTINUE BELOW

x .0045 $.
X 003.
xX .003

‘State reporting Ext rate period Dates and amounts of contributi Contributic tual
number a8 shown Taxable Payroll ps p Experience tions ions actually
‘on employer's State (As defined in State act) |" From— | To tate art Panaay ae aid to State before

contribution returns

TO THE DISTRICT DIRECTOR OF INTERNAL REVENUE:
I hereby certify that, except as noted above, the records of this office agree with the entries made by the employer in columns (2), (3), (4), (5), and (9) of
Schedule A, and that ali contributions were paid before February 1.

Name of ‘Name of
State Officer .. State -
[7 Name (as distinguished from trade name) Calendar Year 47 U.S. TREASURY DEPARTMENT
. District Director of tnternal Revenue
Employer's 1965
name, Trade name, if any Identification No, PoTRICIAL BUSINESS |
address, >
identification Address POSTMASTER: Ii undeliverable
number and treatin accordance with Sectior
von 355.56 of Postal Manual.
calendar
year, Entries must be made beth above and below this line -: a ~—---
(it not Name (as distinguished from trade name) Calendar Year
correctly 1965 .
printed, Trade name, it any Identification No ul
please > P
shange.) Address !
T
L a

If no longer in business write “Final.”

15. Total taxable wages paid during calendar year (From Schedule B, on other side) .......-......+55-5
16. Gross Federal tax (3.1% of wages in Item 15).
17. Less: Credit from Item 14 of Schedule A . . :
18. Remainder of tax (Item 16 minus Item 17). Pay to “INTERNAL REVENUE SERVICE” —,

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 which is claimed as a credit in Item 17 above was or is to be deducted
from the remuneration of employees.

~~ Signature) (Title (Owner, president, partner, member, et.)) Ditey

BE SURE TO ENCLOSE REMITTANCE WITH THIS RETURN (Form 940)
FILE THIS FORM WITH YOUR DISTRICT DIRECTOR OF INTERNAL REVENUE NOT LATER THAN JANUARY 31, 1966

16~78965-1


Page 2

HOW TO PREPARE SCHEDULE A—COMPUTATION OF CREDIT AGAINST FEDERAL UNEMPLOYMENT TAX

Schedule A should be completely and carefully filled in, in accordance
with the numbered items below, in order that the correct amount of
credit can be determined. All columns (1 to 9) of this schedule are to
be used by taxpayers who have been granted an “experience rate” lower
than 2.7 percent by a State for the whole, or part, of the taxable year.
If you have not been granted an “experience rate,” use columns 1, 2, 3,
and 9 only. If you have been granted an “experience rate” higher
than 2.7 percent, use columns 1, 2, 3, 4, 5, and 9 only. If a State has
granted an experience rate on part of your payroll, that part to which
the experience rate does not apply should be entered separately, using
columns 1, 2, 3, and 9 for this purpose. If you were granted an “ex-
perience rate” for a part of the year only, or your “experience rate”

_ was changed during the year, show in the proper columns the period
of the year to which each separate rate applied, the payroll, tate of
contributions, and required contributions with respect to each such period.

Column 1.—Enter in column 1 the name of the State or States (in-
cluding Puerto Rico) to which contributions were required to be paid.

Column 2.—Enter in column 2 your State reporting number as shown
on your State contribution return, If you had employment in more than
one State, enter the reporting number assigned to you by each such State.

Column 3.—Enter in column 3 the taxable payroll on which you are
tequired to pay contributions into the unemployment fund of the State
indicated in column 1 of, if you have been granted an “experience rate”
of zero, the amount upon which you would have been required to make
contributions had such rate not been granted.

Column 4.—Enter in column 4 the period or periods of the year to
which the “experience rate” or rates apply.

Column 5.—Enter in columa 5 the “experience rate” or rates granted
to you by the State or States for the period or periods shown in column 4.

Column 6.—Section 3302(b) of the Federal Unemployment Tax Act
requires a determination of the amount of contributions an employer
with an “experience rate” would have been required to pay if throughout
the taxable year he had been subject to the highest rate applied by the
State in the taxable year to any person having individuals in his employ
or to a rate of 2.7 percent, whichever rate is lower. For the purpose of
this return, the taxpayer should assume that the highest rate applied under
the State law in the taxable year was not lower than 2.7 percent and use

that rate in computing the amount shown in column 6, If it is deter-
mined that the highest rate applied by the State was lower than 2.7
percent, the amount of additional credit computed with respect to such
State will be reduced accordingly.

Column 7.—Multiply the payroll in column 3 by the “experience rate”
in column 5 and enter the result in column 7.

Columa 8.—Subtract the amount in column 7 from the amount in
column 6 and enter the difference in column 8.

Column 9.—Enter in column 9 the amount of contributions actually
paid into the State funds.

Item 10.—Enter the sum of the totals appearing in columns 8 and 9.
Also include the amount of any special credit as explained after Item
13 below.

Item 13.—Enter in Item 13 (a) through (c) the amount (if any) of:
wages, as defined in the Federal Unemployment Tax Act, paid in 1965
which are subject to the unemployment compensation law of the particular
States specified or which are otherwise attributable to these particular
States, (If in doubt, ask the District Director of Internal Revenue.)

Special credit—If special credit is claimed as a successor employer
(see the next-to-last paragraph on page 4) attach a written statement
showing (a) the name, address, and employer identification number of
the predecessor, (b) the method of acquisition of the predecessor's trade+
or business (or a separate unit thereof), (c) the date on which the acqui-
sition occurred, (d) each of the items of information in columns 1 through
9 of Schedule A applicable to the predecessor, (e) the number of indi-
viduals employed by the predecessor immediately prior to the acquisition
were employed by the successor employer immediately after the
ion, (f) the total amount of remuneration, subject to the unem-
ployment compensation law of a State, paid to such employees by the
predecessor during the calendar year. ‘The amount of the special credit
is determined by (1) adding the amounts determined for the predecessors
(in step (d), above) as “Additional credit” and as “Contributions actually
paid to State” and (2) multiplying this total by a fraction of which the
numerator is the amount determined in step (f) above, and the denomi-
nator is the amount determined (in step (d), above) as “Taxable Payroll
(as defined in State Act).”

HOW TO PREPARE SCHEDULE B—COMPUTATION OF TAXABLE WAGES

Line 1—Total remuneration (including exempt remuneration)
PAID during the calendar year for services of employees—Enter in
line 1 of Schedule B the total amount of remuneration for services paid
to employees during the calendar year, regardless of whether such remu-
neration is taxable. Such remuneration should include salaries, wages,
commissions, fees, bonuses, vacation allowances, salaries and wages paid
to temporary or part-time employees, the value of goods, lodging, food
and clothing, and all amounts deducted from employees’ wages as
employee tax or as deductions for other reasons. The basis upon which
the remuneration is paid is immaterial in determining whether the remu-
neration constitutes wages. Thus, it may be paid on the basis of piece-
work, or a percentage of profits; and it may be paid hourly, daily, weekly,
monthly, or annually.

The medium in which the remuneration is paid is also immaterial, It
may be paid in cash or in something other than cash, as for example,
goods, lodging, food, or clothing. Remuneration paid in items other
than cash should be computed oa the basis of the fair value of such items
at the time of payment.

Exempt remuneration—The terms “wages” and “employment” as

GPO 16~78905-1

defined for Federal unemployment tax purposes do not include every
payment of remuneration to an employee and every kind of service which
an employee may perform. In general, any remuneration which is ex-
cluded from “wages” and any remuneration for services which are
excepted from “employment,” are not included in the total wages subject
to the tax. These remuneration payments may be deducted from the total
remuneration paid only if they are identified in Schedule B.

Line 2—Enter in line 2 the approximate number of employees who
received more than $3,000 from you during the year and the aggregate
amount of the excess above $3,000 paid to all such employees. For
example, assume that you had 10 employees, and that you paid each of
them $5,000 during the year. $50,000 should be included in line 1 and
$20,000 in line 2.

Line 3.—Enter in line 3 such items as (1) Agricultural labor, (2)
benefit payments for sickness or injury, under a workmen's compensation
law, insurance plan and certain employer plans, (3) domestic service, (4)
family employment, (5) certain fishing activities, and (6) any other
exempt payments or services. For mote definite information with respect
to these exemptions, see Citcular E, Employer's Tax Guide.

(for General Instructions, see back of copy for employer)

Schedule B—COMPUTATION OF TAXABLE WAGES

1. Total remuneration (including exempt remuneration) PAID during the calendar year for services of

employees. .

Exempt remuneration:
LIST EACH TYPE OF EXEMPTION

Approximate number of
employees involved

2. Remuneration in excess of $3,000. (Enter only the excess

over the first $3,000 paid to individual employees)...... 7
3. All other exemptions (Explain each exemption shown, at-
taching additional sheet if necessary):

4, Total exempt remuneration.....

XXXXXXX/|XXXXXXXX

5. Total taxable wages (line 1 minus line 4).
ero 10—78905-1



FORM 940 EMPLOYER’S ANNUAL FEDERAL UNEMPLOYMENT TAX RETURN—1965
U.S. Treasury Department — Internal Revenue Service
Schedule A— COMPUTATION OF CREDIT AGAINST FEDERAL UNEMPLOYMENT TAX

State reporting number Expatience rate period Contributions had | Gontributions payable ‘Adsitonal Contribution
Mame of State | as shown on empioyer’s Tarbie Paral |__| Experiont | rate bean 2.7 at expetiece ite credit seta ald
State contribution returns | (AS defined in State act) from— |} To fd (Gol. 3 X 2.1%) (Gob 3 > col. 6) (cob 6 minus col. 7) a saie
a) @) @) 3) (3) @ (8) (0

TOTALS. . XXX) xxx | xx | xxx x | xxxxxx

10. Total tentative credit (Column 8 plus column 9).....

11. Enter here 2.7% of amount of wages in Item 15 below.

12. Item 10 or 11 whichever is smaller
13. Amount, if any, of wages in Item 15 attributable to the following States:

a. Alaska xX .0045 $.

b. New Jersey. ..

c. West Virginia.

Total (add amounts from lines a through c)

14, Credit allowable (Item 12 less Item 13). Enter here and in Item 17

THIS COPY MUST BE
KEPT BY EMPLOYER

This copy, and each related schedule or statement which the employer is required to keep, must be carefully preserved by the
employer, for a period of 4 years after the date the tax is due, or the date the tax is paid, whichever is the later. Such copies should
at all times during this period be available for inspection by officers of the Internal Revenue Service.

ot =

\ Calendar Year
\ 1965

Identification No.

If no longer In business write “Fi

15. Total taxable wages paid during calendar year (From Schedule B, on other side) .
16. Gross Federal tax (3.1% of wages in Item 15)...
17. Less: Credit from Item 14 of Schedule A
18. Remainder of tax (Item 16 minus Item 17). Pay to “INTERNAL REVENUE SERVIC)

IMPORTANT.—Before filing the return be sure to enter on this copy your name, address, and identification number.
10780051