940 for 2009:

OMB No. 1545-0028

Employer’s Annual Federal Unemployment (FUTA) Tax Return

Department of the Treasury — Internal Revenue Service

850109

Employer identification number

Name (not your trade name)

Trade name (if any)

Address Number Street Suite or room number

City State ZIP code

Read the separate instructions before you fill out this form. Please type or print within the boxes.

Type of Return

(Check all that apply.)

a. Amended

b. Successor employer

c. No payments to employees

in 2009

d. Final: Business closed or

stopped paying wages

Form

—

Part 1: Tell us about your return. If any line does NOT apply, leave it blank.

1

3

4

5

6

7

8

9

10

11

12

13

1a

If you were required to pay your state unemployment tax in ...

Check here. Fill out Schedule A.

Payments exempt from FUTA tax

Check one: Apply to next return.

Send a refund.

Next

1b

3

6

8

9

10

11

12

4a

7

.



For Privacy Act and Paperwork Reduction Act Notice, see the back of Form 940-V, Payment Voucher. Cat. No. 11234O Form 940 (2009)

(EIN)

You MUST fill out both pages of this form and SIGN it.

One state only, write the state abbreviation

- OR -

More than one state (You are a multi-state employer)

1a

Part 2: Determine your FUTA tax before adjustments for 2009. If any line does NOT apply, leave it blank.

Total payments to all employees

4 . Check all that apply: Fringe benefits 4c Retirement/Pension 4e Other

4b Group-term life insurance 4d Dependent care

Total of payments made to each employee in excess of

$7,000 5 . .

.

.

Subtotal (line 4 + line 5 = line 6)

Total taxable FUTA wages (line 3 – line 6 = line 7)

FUTA tax before adjustments (line 7 .008 = line 8)

Part 3: Determine your adjustments. If any line does NOT apply, leave it blank.

.

.

. Part 4: Determine your FUTA tax and balance due or overpayment for 2009. If any line does NOT apply, leave it blank.

If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax, 

multiply line 7 by .054 (line 7 .054 = line 9). Then go to line 12

If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax,

OR you paid ANY state unemployment tax late (after the due date for filing Form 940), fill out

the worksheet in the instructions. Enter the amount from line 7 of the worksheet

If credit reduction applies, enter the amount from line 3 of Schedule A (Form 940)

.

.

.

.

13

14

15

14

15

Total FUTA tax after adjustments (lines 8 + 9 + 10 + 11 = line 12)

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

Balance due (If line 12 is more than line 13, enter the difference on line 14.)

Overpayment (If line 13 is more than line 12, enter the difference on line 15 and check a box

below.)

● If line 14 is more than $500, you must deposit your tax.

● If line 14 is $500 or less, you may pay with this return. For more information on how to pay, see

the separate instructions

1b

2 If you paid wages in a state that is subject to CREDIT REDUCTION 2 Check here. Fill out Schedule A

(Form 940), Part 2.
Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for

a quarter, leave the line blank.

8 0209

Part 5: Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6.

Preparer’s

signature

Firm’s name (or yours 

if self-employed)

Address

EIN

ZIP code

Check if you are self-employed

Page 2 Form 940 (2009)

Name (not your trade name) Employer identification number (EIN)

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 made to employees. Declaration of

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

✗ Sign your

name here

Date / / Best daytime phone () –

16

16a 1st quarter (January 1 – March 31)

2nd quarter (April 1 – June 30)

3rd quarter (July 1 – September 30)

4th quarter (October 1 – December 31)

16b

16c

16d

16a .

.

.

.

16b

16c

16d

17 Total tax liability for the year (lines 16a + 16b + 16c + 16d = line 17) 17 . Total must equal line 12.

Part 6: May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions

for details.

Yes. Designee’s name and phone number

Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS

No.

Part 7: Sign here. You MUST fill out both pages of this form and SIGN it.

Print your

name here

Print your

title here

Preparer’s name

Preparer’s

SSN/PTIN

Date / /

City State

Paid preparer’s use only

() –

() – Phone

5
Form 940-V,

Payment Voucher

What Is Form 940-V?

Form 940-V is a transmittal form for your check or

money order. Using Form 940-V allows us to process

your payment more accurately and efficiently. If you

have any balance due of $500 or less on your 2009

Form 940, fill out Form 940-V and send it with your

check or money order.

How Should You Prepare Your Payment?

● Make your check or money order payable to the

United States Treasury. Do not send cash.

Type or print clearly.

How Do You Fill Out Form 940-V?

Box 1. Enter your employer identification number (EIN).

Do not enter your social security number (SSN).

Note. If your balance is more than $500, see When

Must You Deposit Your FUTA Tax? in the Instructions

for Form 940.

Enter the amount of your payment. 

2

 Detach Here and Mail With Your Payment and Form 940. 

OMB No. 1545-0028

Form 940-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

Enter your employer identification number

(EIN).

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

Do not staple or attach this voucher to your payment.

Enter your address.

Enter your city, state, and ZIP code.

1 Dollars Cents

Box 2. Enter the amount of your payment. Be sure to

put dollars and cents in the appropriate spaces.

Box 3. Enter your business name and complete

address exactly as they appear on your Form 940.

● On the memo line of your check or money order,

write:

— your EIN,

● Carefully detach Form 940-V along the dotted line.

● Do not staple your payment to the voucher.

● Mail your 2009 Form 940, your payment, and Form

940-V in the envelope that came with your 2009

Form 940 instruction booklet. If you do not have

that envelope, use the table in the Instructions for

Form 940 to find the mailing address.

— Form 940, and

— 2009.

✁ ✃

2009
You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books and records relating to a form

or instructions must be retained as long as their

contents may become material in the administration of

any Internal Revenue law.

23, Federal Unemployment Tax Act, of Subtitle C,

Employment Taxes, of the Internal Revenue Code

imposes a tax on employers with respect to

employees. This form is used to determine the amount

of the tax that you owe. Section 6011 requires you to

provide the requested information if you are liable for

FUTA tax under section 3301. Section 6109 requires

taxpayers and paid preparers to provide their

identification numbers. If you fail to provide this

information in a timely manner, you may be subject to

penalties and interest.

The time needed to complete and file this for

vary depending on individual circumstances. Th

estimated average time is: Recordkeeping, 9 hr

min.; Learning about the law or the form, 1 hr., 

min.; Preparing and sending the form to the IRS

36 min.

If you have comments concerning the accura

these time estimates or suggestions for making 

940 simpler, we would be happy to hear from y

can write to: Internal Revenue Service, Tax Pro

Coordinating Committee, SE:W:CAR:MP:T:SP, 

Constitution Avenue, NW, IR-6526, Washington

20224. Do not send Form 940 to this address. 

see Where Do You File? on page 2 of the Instr

for Form 940.

Generally, tax returns and return information are

confidential, as required by section 6103. However,

section 6103 allows or requires the IRS to disclose or

give the information shown on your tax return to others

commonwealths and possessions to administe

tax laws. We may also disclose this information 

other countries under a tax treaty, to federal an

agencies to enforce federal non-tax criminal law

federal law enforcement and intelligence agenc

combat terrorism.