Annual Return of Withheld Federal Income Tax

Form 945

Department of the Treasury

Internal Revenue Service Please type or print.

IRS USE ONLY

Name (as distinguished from trade name) Employer identification number T

Trade name, if any

FF

FD

Address (number and street)

FP

I

T

If address is

different

from prior

return, check

here 

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

2 Backup withholding 2

 See separate instructions. For more information on income tax withholding, see Circular E and Pub. 15-A.

OMB No. 1545-1430

3

4

5

3

4

5

Total taxes. If $2,500 or more, this must equal line 8M below or line M of Form 945-A

Total deposits for 2001 from your records, including overpayment applied from a prior year

6 Balance due (subtract line 5 from line 4). See instructions

Overpayment. If line 4 is less than line 5, enter overpayment here  $ and check if to be:

Applied to next return OR Refunded

Monthly Summary of Federal Tax Liability. Do not complete if you are a semiweekly schedule depositor.

Tax liability for month

A January 

B

C

D

E

F

G

H

I

J

K

L

Total liability for

year (add entries A

through L)

M

February

March 

April 

May 

June 

July

August

September 

October 

November

December

Tax liability for month Tax liability for month

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 14584B Form 945 (2001)

City, state, and ZIP code

8

Enter state code

for state in

which deposits

were made only

if different from

state in address

to the right

(see page 3 of

instructions). 

IRS Use

● Monthly schedule depositors: Complete line 8, entries A through M, and check here 

● Semiweekly schedule depositors: Complete Form 945-A and check here 

● All filers: If line 4 is less than $2,500, you need not complete line 8 or Form 945-A.

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

Adjustment to correct administrative errors (see instructions)

6

7

If you do not have to file returns in the future, check here  and enter date final payments paid 

1 1 1 1 1 1 1 1 1 2 3 3 3 3 3 3 4 4 4

6 9 7 8 8 8 8 9 9 10 10 10 10 10 10 10 10 10 10

1 3 3 555

8 9 8 8 8

2001

Person’s

name 

Do you want to allow another person to discuss this return with the IRS (see separate instructions)? Third

Party

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge Sign and belief, it is true, correct, and complete.

Here Print Your

Signature  Name and Title  Date 
Purpose of Form

We will credit your payment more promptly and

accurately and improve our service to you if you use

Form 945-V to make a payment with Form 945,

Annual Return of Withheld Federal Income Tax.

Otherwise, you are required to deposit the payment

at an authorized financial institution or by electronic

funds transfer (see section 11 of Circular E for deposit

instructions). Do not use the Form 945-V payment

voucher to make Federal tax deposits.

Form 945-V

Payment Voucher

Make payments with your 2001 Form 945 only if:

Making Payments With Form 945

1. Your total taxes for the year (line 4 on Form 945)

are less than $2,500 and you are paying in full with a

timely filed return or

2. You are a monthly schedule depositor making a

payment in accordance with the Accuracy of

Deposits rule (see section 11 of Circular E,

Employer’s Tax Guide (Pub. 15), for details). This

payment may exceed $2,500.

Caution: If you make payments with Form 945 that

should have been deposited, you may be subject to a

penalty. See Circular E.

Specific Instructions

● Make your check or money order payable to the

United States Treasury. Be sure to enter your EIN,

“Form 945,” and “2001” on your check or money

order. Do not send cash. Please do not staple your

payment to the voucher or the return or to each other.

● Detach the completed voucher and send it with your

payment and Form 945 to the address provided in the

separate Instructions for Form 945.

Form 945-V

Department of the Treasury

Internal Revenue Service

Form 945 Payment Voucher OMB No. 1545-1430

Cat. No. 20563G

Box 2. Enter the amount paid with Form 945.

Box 1. If you do not have an EIN, apply for one on

Form SS-4, Application for Employer Identification

Number, and write “Applied for” and the date you

applied in this entry space.

Box 3. Enter your business name and address as

shown on Form 945.

1 2

3

Enter the amount of the payment you are

making

Enter your employer identification number

Enter your business name (individual name for sole proprietors)

Enter your address

Enter your city, state, and ZIP code

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 945.

 Use this voucher when making a payment with your return. 2001

Dollars Cents