OMB No. 1545-0028 Employer’s Annual Federal

Unemployment (FUTA) Tax Return Form 940

Department of the Treasury

Internal Revenue Service © For Paperwork Reduction Act Notice, see separate instructions.

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FF

FD

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Yes No

If you will not have to file returns in the future, check here, complete, and sign the return ©

Computation of Taxable Wages

1 Total payments (including exempt payments) during the calendar year for services of employees 1

Amount paid Exempt payments. (Explain each exemption shown, attach 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. Do not include payments

from line 2. The $7,000 amount is the Federal wage base. Your state

wage base may be different. Do not use the state wage limitation

3

3

4 Total exempt payments (add lines 2 and 3) 4

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

Form 940 (1995)

Part I

If this is an Amended Return, check here ©

A Are you required to pay unemployment contributions to only one state? (If no, skip questions B and C.)

B

C

Be sure to complete both sides of this return and sign in the space provided on the back.

Name (as distinguished from trade name) Calendar year

Trade name, if any

Address and ZIP code Employer identification number

Did you pay all state unemployment contributions by January 31, 1996? (If a 0% experience rate is granted,

check “Yes.”) (If no, skip question C.)

Were all wages that were taxable for FUTA tax also taxable for your state’s unemployment tax?

If you answered “No” to any of these questions, you must file Form 940. If you answered “Yes” to all the

questions, you may file Form 940-EZ, which is a simplified version of Form 940. You can get Form 940-EZ by

calling 1-800-TAX-FORM (1-800-829-3676).

Yes No

Yes No

Cat. No. 11234O

Form 940-V

Department of the Treasury

Internal Revenue Service

Form 940 Payment Voucher

Enter the amount of the payment you are making Enter the first four characters of your

business name

1 2

4 Enter your name

DETACH HERE

OMB No. 1545-0028

© $ .

For Paperwork Reduction Act Notice, see Form 940 instructions.

3 Enter your employer identification number

Enter your address

Enter your city, state, and ZIP code

Complete boxes 1,2,3, and 4. Make your check or money order payable to the Internal Revenue Service. Include your employer identification number

on your check or money order. Do not send cash.

Do not staple your check or money order

to the voucher or the return.
Tax Due or Refund

1 Gross FUTA tax. Multiply the wages in Part l, line 5, by .062 1

2 Maximum credit. Multiply the wages in Part l, line 5, by .054 2

3

Total FUTA tax (subtract line 6 from line 1)

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

5

Balance due (subtract line 8 from line 7). This should be $100 or less. Pay to the Internal Revenue

Service. See page 3 of the Instructions for Form 940 for details ©

6

7

Overpayment (subtract line 7 from line 8). Check if it is to be: Applied to next return,

or Refunded ©

7

Record of Quarterly Federal Unemployment Tax Liability ( Do not include state liability)

Quarter First Second Third Fourth Total for year

Liability for quarter

(a)

Name

of

state

(i)

Contributions

actually paid

to state

(h)

Additional credit

(col. (f) minus col.(g)).

If 0 or less, enter -0-.

(g)

Contributions

payable at experience

rate (col. (c) x col. (e))

(f)

Contributions if

rate had been 5.4%

(col. (c) x .054)

(e)

State experience

rate

(b)

State reporting number(s)

as shown on employer’s

state contribution returns

(c)

Taxable payroll

(as defined in state act)

(d)

State experience rate period

From To

Totals ©

Total tentative credit (add line 3a, columns (h) and (i) only—see instructions for limitations on late payments) ©

Form 940 (1995) Page 2

Part III

Computation of tentative credit (Note: All taxpayers must complete the applicable columns.)

3a

3b

4

9

8

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 ©

8

9

Credit: Enter the smaller of the amount in Part II, line 2, or line 3b

10

10

Part II

6
OMB No. 1545-0028 Employer’s Annual Federal

Unemployment (FUTA) Tax Return Form 940

Department of the Treasury

Internal Revenue Service © For Paperwork Reduction Act Notice, see separate instructions.

Yes No

If you will not have to file returns in the future, check here, complete, and sign the return ©

Computation of Taxable Wages

1 Total payments (including exempt payments) during the calendar year for services of employees 1

Amount paid Exempt payments. (Explain each exemption shown, attach 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. Do not include payments

from line 2. The $7,000 amount is the Federal wage base. Your state

wage base may be different. Do not use the state wage limitation

3

3

4 Total exempt payments (add lines 2 and 3) 4

5 5

Part I

If this is an Amended Return, check here ©

A Are you required to pay unemployment contributions to only one state? (If no, skip questions B and C.)

B

C Were all wages that were taxable for FUTA tax also taxable for your state’s unemployment tax?

If you answered “No” to any of these questions, you must file Form 940. If you answered “Yes” to all the

questions, you may file Form 940-EZ, which is a simplified version of Form 940. You can get Form 940-EZ by

calling 1-800-TAX-FORM (1-800-829-3676).

Yes No

Yes No

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

Form 940 (1995)

Did you pay all state unemployment contributions by January 31, 1996? (If a 0% experience rate is granted,

check “Yes.”) (If no, skip question C.)
Computation of tentative credit (Note: All taxpayers must complete the applicable columns.)

Note: You must keep this copy and a copy of each related schedule or statement for 4 years after the date the tax is due or paid, whichever

is later. These copies must be available for inspection by the IRS. See Circular E, Employer’s Tax Guide, and Pub. 15-A, Employer’s

Supplemental Tax Guide, for more information. Household employers should see Schedule H (Form 1040) and its related instructions.

Tax Due or Refund

1 Gross FUTA tax. Multiply the wages in Part l, line 5, by .062 1

2 Maximum credit. Multiply the wages in Part l, line 5, by .054 2

3

Total FUTA tax (subtract line 6 from line 1)

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

5

6

Balance due (subtract line 8 from line 7). This should be $100 or less. Pay to the Internal Revenue

Service. See page 3 of the Instructions for Form 940 for details ©

6

7

Overpayment (subtract line 7 from line 8). Check if it is to be: Applied to next return,

or Refunded ©

7

Record of Quarterly Federal Unemployment Tax Liability ( Do not include state liability)

Quarter First Second Third Fourth Total for year

Liability for quarter

(a)

Name

of

state

(i)

Contributions

actually paid

to state

(h)

Additional credit

(col. (f) minus col.(g)).

If 0 or less, enter -0-.

(g)

Contributions

payable at experience

rate (col. (c) x col. (e))

(f)

Contributions if

rate had been 5.4%

(col. (c) x .054)

(e)

State experience

rate

(b)

State reporting number(s)

as shown on employer’s

state contribution returns

(c)

Taxable payroll

(as defined in state act)

(d)

State experience rate period

From To

Totals ©

Total tentative credit (add line 3a, columns (h) and (i) only—see instructions for limitations on late payments) ©

Form 940 (1995) Page 4

Part III

3a

3b

4

9

8

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 ©

8

9

10

10

Part II

Credit: Enter the smaller of the amount in Part II, line 2, or line 3b

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