Employer’s Annual Tax Return for Agricultural Employees OMB No. 1545-0035

Form 943

Department of the Treasury

Internal Revenue Service

T Enter your name,

address, employer

identification

number, and

calendar

year of return.

FF

Name (as distinguished from trade name) Calendar year FD

FP

Employer identification number  Trade name, if any I

T

Address and ZIP code If address is different

from prior return,

check here 

If you do not

have to file

returns in the

future, check

here 

For Privacy Act and Paperwork Reduction Act Notice, see page 3 of separate instructions.

 See separate Instructions for Form 943 for information on completing this return.

1 Number of agricultural employees employed in the pay period that includes March 12, 2001  1

2 2

3 Social security taxes (multiply line 2 by 12.4% (.124)) 3

4 Total wages subject to Medicare taxes (see instructions) 4

5 Medicare taxes (multiply line 4 by 2.9% (.029)) 5

6 Federal income tax withheld (see instructions) 6

7 Total taxes before adjustments (add lines 3, 5, and 6) 7

8

Advance earned income credit (EIC) payments, if any (see instructions)

8

9

Net taxes (subtract line 10 from line 9)

9

10

Total deposits for 2001, including overpayment applied from 2000

10

Balance due (subtract line 12 from line 11). See instructions 

11

13

14 Overpayment. If line 12 is more than line 11, enter here  $ and check if to be: Applied to next return or Refunded.

● All filers: If line 11 is less than $2,500, do not complete line 15 or Form 943-A.

Deposit period ending Tax liability for month

A January 31

B

C

D

E

F

G

H

I

J

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.

Print Your

Signature  Name and Title  Date 

Total wages subject to social security taxes (see instructions)

Adjustment to taxes (see instructions)

Total taxes (line 7 as adjusted by line 8)

12

13

11

12

February 28

March 31

April 30

May 31

June 30

July 31

August 31

September 30

October 31

Deposit period ending Tax liability for month Tax liability for month

Total liability for

year (add lines A

through L)

M

November 30

December 31

Deposit period ending

Form 943-V

Department of the Treasury

Internal Revenue Service

Form 943 Payment Voucher

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, “Form 943”, and “2001” on your payment.

 DETACH HERE 

● Semiweekly schedule depositors: Complete Form 943-A and check here  ● Monthly schedule depositors: Complete line 15 and check here 

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

 Use this voucher when making a payment with your return.

K

L

Sign

Here

Cat. No. 11252K

1 Your employer identification number Dollars

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

Enter your address

Enter your city, state, and ZIP code

Form 943 (2001)

2001

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 identifying

( ) number (PIN) 

Yes. Complete the following. No.

2001

Enter the amount of your payment 

2 Cents
Purpose of Form

Complete Form 943-V if you are making a payment

with Form 943, Employer’s Annual Tax Return for

Agricultural Employees. We will use the completed

voucher to credit your payment more promptly and

accurately, and to improve our service to you.

Otherwise, you must deposit the amount at an

authorized financial institution or by electronic funds

transfer. Do not use the Form 943-V payment voucher

to make Federal tax deposits.

Specific Instructions

Box 1—Employer identification number (EIN). 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.

● Make your check or money order payable to the

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

“Form 943”, and “2001” on your check or money

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

voucher or your payment to the return or to each

other.

● Detach the completed voucher and send it with your

payment and Form 943 to the address provided in the

separate Instructions for Form 943.

Instructions for Form 943

Payment Voucher

Make a payment with your 2001 Form 943 only if:

Making Payment With Form 943

1. Your net taxes for the year (line 11 on Form 943)

are less than $2,500 and the taxes are paid 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 7 of Circular A,

Agricultural Employer’s Tax Guide (Pub. 51), for

details.) This amount may be $2,500 or more.

Caution: If you pay an amount with Form 943 that

should have been deposited, you may be subject to a

penalty. See Circular A.

If you have your return prepared by a third party and

make a payment with that return, please provide this

payment voucher to the return preparer. Box 3—Name and address. Enter your business

name and address as shown on Form 943.

Box 2—Amount of payment. Enter the amount paid

with Form 943.