Employer’s Annual Federal OMB No. 1545-1110

Unemployment (FUTA) Tax Return Form 940-EZ

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name) Calendar year FF

FD

Trade name, if any Employer identification number (EIN) FP

Address (number and street)

T

I

T

Answer the questions under Who May Use Form 940-EZ on page 2. If you cannot use Form 940-EZ, you must use Form 940.

A Enter the amount of contributions paid to your state unemployment fund (see separate instructions) 

B (1) Enter the name of the state where you have to pay contributions 

(2) Enter your state reporting number as shown on your state unemployment tax return 

If this is an Amended Return, check here (see Amended Returns in the separate instructions) 

Taxable Wages and FUTA Tax

1 Total payments (including payments shown on lines 2 and 3) during the calendar year for services of employees 1

Exempt payments. (Explain all exempt payments, attaching additional sheets

if necessary.) 

2

2

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

paid to each employee (see separate instructions)

3

3

4 Add lines 2 and 3 4

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

6 FUTA tax. Multiply the wages on line 5 by .008 and enter here. (If the result is over $100, also complete Part II.) 6

7 Total FUTA tax deposited for the year, including any overpayment applied from a prior year 7

8 Balance due (subtract line 7 from line 6). Pay to the “United States Treasury.”  8

9 Overpayment (subtract line 6 from line 7). Check if it is to be: 9

Record of Quarterly Federal Unemployment Tax Liability (Do not include state liability.) Complete only if line 6 is over $100.

Quarter First (Jan. 1 – Mar. 31) Second (Apr. 1 – June 30) Third (July 1 – Sept. 30) Fourth (Oct. 1 – Dec. 31) Total for year

Liability for quarter

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 

Form 940-EZ (2003)

If you will not have to file returns in the future, check here (see Who Must File in separate instructions) and complete and sign the return. 

$

Part I

Part II

Cat. No. 10983G

(99)

Form 940-EZ(V)

Department of the Treasury

Internal Revenue Service

Payment Voucher

DETACH HERE

OMB No. 1545-1110

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

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

“United States Treasury.” Be sure to enter your employer identification number (EIN), “Form 940-EZ,” and “2003” on your payment.

 See separate Instructions for Form 940-EZ for information on completing this form.

Applied to next return or Refunded 

If you owe more than $100, see Depositing FUTA tax in separate instructions.

1 2 Enter your employer identification number (EIN).

3 Enter your business name (individual name for sole proprietors).

Enter the amount of your payment. 

Enter your address.

Enter your city, state, and ZIP code.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Designee’s

name 

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

Party

Designee Phone

no. 

Personal identification

( ) number (PIN) 

Yes. Complete the following. No



 You must

complete

this section.

Dollars Cents

2003

City, state, and ZIP code

2003
Form 940-EZ (2003) Page 2

Who May Use Form 940-EZ

**If you deposited all FUTA tax when due, you may answer “Yes” if you paid all state

unemployment contributions by February 10, 2004.

The following chart will lead you to the right form to use—

Did you pay unemployment

contributions to only one

state?*

Did you pay all state

unemployment

contributions by

February 2, 2004?**

Were all wages that were

taxable for FUTA tax also

taxable for your state’s

unemployment tax?

You may use

Form 940-EZ.

You must use

Form 940.

* Do not file Form 940-EZ if— ● You owe FUTA tax only for household work in a private home. See Schedule H (Form 1040).

● You are a successor employer claiming a credit for state unemployment contributions paid

by a prior employer. File Form 940.



Yes



Yes



Yes





No

No 

No