OMB No. 1545-0035

Form 943 Employer’s Annual Federal Tax Return for Agricultural Employees

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name)

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

Address (number and street)

If address is

different from

prior return,

check here. ©

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

© See the separate instructions for Form 943 for information on completing this return.

1

*Report wages, including those paid to qualified new employees, on lines 2 and 4. The social security tax exemption on wages

will be figured on line 7c and will reduce the tax on line 7d (see instructions).

1

2 2

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

4 Total wages subject to Medicare tax* (see separate instructions) 4

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

6 Federal income tax withheld (see separate instructions) 6

7c Social security tax exemption (multiply line 7b by 6.2% (.062)) 7c

8

Advance earned income credit (EIC) payments made to employees, if any (see separate instructions)

8

9

Net taxes (subtract line 10 from line 9)

9

10

Total deposits for 2010, including overpayment applied from a prior year and Form 943-X 

10

Balance due. If line 11 is more than 14, write the difference here. For information on how to pay, 

see the instructions ©

11

15

16 Overpayment. If line 14 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 17 or Form 943-A.

Tax liability for month

A January

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

Print Your

Signature © Name and Title © Date ©

Total wages subject to social security tax* (see separate instructions)

Current year’s adjustments (see separate instructions) 

Total taxes after adjustments (line 7d as adjusted by line 8) 

12

15

11

12

February

March

April

May

June

July

August

September

October

Tax liability for month Tax liability for month

Total liability for year

(add lines A 

through L) 

M

November

December

● Semiweekly schedule depositors: Complete Form 943-A and check here © ● Monthly schedule depositors: Complete line 17 and check here ©

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

K

L

Sign

Here

Cat. No. 11252K Form 943 (2010)

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.

City, state, and ZIP code

Enter state code

for state in which

deposits were

made only if

different from

state in address

to the right ©

(see the separate

instructions).

If you do not have

to file returns in the

future, check

here ©

2010

13a COBRA premium assistance payments (see instructions)

13b Number of individuals provided COBRA premium assistance 

14 Add lines 12, 13a, and 13e 14

13a

Calendar year

Number of agricultural employees employed in the pay period that includes March 12, 2010 ©

7a Number of qualified employees paid wages after March 31, 2010 7a

7b Exempt wages paid to qualified employees after March 31, 2010 7b

7d Total taxes before adjustments (lines 3 + line 5 + line 6 – line 7c) 7d

See instructions for definitions

of qualified employee and

exempt wages.

13c Number of qualified employees paid exempt wages March 19-31 13c

13d Exempt wages paid to qualified employees March 19-31 13d

13e Social security tax exemption (multiply line 13d by 6.2% (.062) 13e

13b

Firm’s EIN ©

Date PTIN Paid

Preparer 

Use Only

Check if

self-employed

Firm’s name ©

Firm’s address © Phone no.

Print/Type preparer’s name Preparer’s signature
Purpose of Form

Complete Form 943-V, Payment Voucher, if you are

making a payment with Form 943, Employer’s Annual

Federal 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 your payment by using

the Electronic Federal Tax Payment System (EFTPS).

See section 7 of Pub. 51 (Circular A) for deposit

instructions. Do not use Form 943-V 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.

● Enclose your check or money order made payable to

the “United States Treasury.” Be sure to enter your

EIN, “Form 943,” and “2010” on your check or money

order. Do not send cash. Do not attach Form 943-V or

your payment to Form 943 (or to each other).

● Detach Form 943-V and send it with your payment

and Form 943 to the address provided in the

Instructions for Form 943.

Form 943-V,

Payment Voucher

To avoid a penalty, make your payment with your 2010

Form 943 only if:

Making Payment With Form 943

● Your net taxes for the year (line 11 on Form 943) are

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

timely filed return, or

● You are a monthly schedule depositor making a

payment in accordance with the Accuracy of Deposits

Rule. See section 7 of Pub. 51 (Circular A), Agricultural

Employer’s Tax Guide, for details. In this case, the

amount of your payment may be $2,500 or more.

Caution. Use Form 943-V when making any payment

with Form 943. However, if you pay an amount with

Form 943 that should have been deposited, you may

be subject to a penalty. See Deposit Penalties in

section 7 of Pub. 51 (Circular A).

If you have your return prepared by a third party and

make a payment with that return, please provide

Form 943-V to the return preparer.

Note. You must also complete the entity information

above line 1 on Form 943.

Box 2—Amount paid. Enter the amount paid with

Form 943.

Box 3—Name and address. Enter your name and

address as shown on Form 943.

Form 943-V

Department of the Treasury

Internal Revenue Service

Payment Voucher OMB No. 1545-0035

1 2

3

Enter the amount of your payment ©

Enter your employer identification number (EIN).

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

Enter your address.

Enter your city, state, and ZIP code.

Dollars Cents

Ä Detach Here and Mail With Your Payment and Form 943. Ä 

© Do not attach this voucher or your payment to Form 943.

✁ ✃

2010