Form 945-X:

(Rev. February 2012)

Adjusted Annual Return of Withheld Federal Income Tax or Claim for Refund

Department of the Treasury — Internal Revenue Service OMB No. 1545-1430

Employer identification number 

(EIN)

—

Name (not your trade name)

Trade name (if any)

Address

Number Street Suite or room number

City State ZIP code

Return You Are Correcting ...

Enter the calendar year of the return 

you are correcting: 

(YYYY) 

Enter the date you discovered errors:

(MM / DD / YYYY) 

Use this form to correct administrative errors made on Form 945, Annual Return of Withheld Federal Income Tax. Use a separate 

Form 945-X for each year that needs correction. Please type or print within the boxes. Do not attach this form to Form 945. 

You MUST complete both pages. Read the separate instructions before you complete this form. 

Part 1: Select ONLY one process. 

1. Adjusted return of withheld federal income tax. Check this box if you underreported amounts. Also check this box if you overreported 

amounts and you would like to use the adjustment process to correct the errors. You must check this box if you are correcting both 

underreported and overreported amounts on this form. The amount shown on line 5, if less than zero, may only be applied as a credit to 

your Form 945 for the tax period in which you are filing this form. 

2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement of 

the amount shown on line 5. Do not check this box if you are correcting ANY underreported amounts on this form. 

Part 2: Enter the corrections for the calendar year you are correcting. If any line does not apply, leave it blank. 

Column 1 

Total corrected 

amount 

(for ALL payees) 

— 

Column 2 

Amount originally 

reported or as 

previously corrected 

(for ALL payees) 

= 

Column 3 

Difference 

(If this amount is a 

negative number, 

use a minus sign.) 

3. Federal income tax withheld 

(from line 1 of Form 945) . . — . = . 

4. Backup withholding 

(from line 2 of Form 945) . . — . = . 

5. Total. Combine the amounts in lines 3 and 4 of Column 3 . . . . . . . . . 

If line 5 is less than zero: 

• If you checked line 1, this is the amount you want applied as a credit to your Form 945 for the tax period in which you are 

 filing this form. 

• If you checked line 2, this is the amount you want refunded or abated. 

If line 5 is more than zero, this is the amount you owe. Pay this amount when you file this return. For information on how to 

pay, see Amount You Owe in the instructions for line 5. 

Next ■▶

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 20336X Form 945-X (Rev. 2-2012) 
Name (not your trade name) Employer identification number (EIN) Calendar Year (YYYY) 

Part 3: Explain your corrections for the calendar year you are correcting. 

6. Check here if any corrections you entered on a line include both underreported and overreported amounts. 

Explain both your underreported and overreported amounts on line 7. 

7. You must give us a detailed explanation of how you determined your corrections. See the separate instructions. 

Part 4: Sign here. You must complete both pages of this form and sign it. 

Under penalties of perjury, I declare that I have filed an original Form 945 and that I have examined this adjusted return or claim and any schedules or 

statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than 

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

✗ Sign your 

name here

Date

Print your 

name here

Print your 

title here

Best daytime phone

Paid Preparer Use Only Check if you are self-employed . . . . . . . .

Preparer’s name 

Preparer’s signature 

Firm’s name (or yours if 

self-employed) 

Address 

City State 

PTIN 

Date 

EIN 

Phone 

ZIP code 

Page 2 Form 945-X (Rev. 2-2012)