Employer’s Annual Federal OMB No. 1545-1110

Unemployment (FUTA) Tax Return Form 940-EZ

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name) Calendar year FF

FD

Trade name, if any FP

Address and ZIP code Employer identification number

T

I

T

Follow the chart under Who May Use Form 940-EZ on page 2. If you cannot use Form 940-EZ, you must use Form 940 instead.

A Enter the amount of contributions paid to your state unemployment fund. (See instructions for line A on page 4.) ©

B (1) Enter the name of the state where you have to pay contributions ©

(2) Enter your state reporting number as shown on state unemployment tax return ©

If this is an Amended Return, check here ©

Taxable Wages and FUTA Tax

1 Total payments (including payments shown on lines 2 and 3) during the calendar year for services of employees 1

Amount paid

Exempt payments. (Explain all exempt payments, attaching additional sheets

if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the first $7,000

paid to each employee. Do not include any exempt payments from line 2. Do not

use your state wage limitation. The $7,000 amount is the Federal wage base. Your

state wage base may be different

3

3

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

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

6 FUTA tax. Multiply the wages on line 5 by .008 and enter here. (If the result is over $100, also complete Part II.) 6

7 Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records) 7

8 Amount you owe (subtract line 7 from line 6). This should be $100 or less. Pay to “Internal Revenue Service.” © 8

9 Overpayment (subtract line 6 from line 7). Check if it is to be: 9

Record of Quarterly Federal Unemployment Tax Liability (Do not include state liability.) Complete only if line 6 is over $100.

Quarter First (Jan. 1 – Mar. 31) Second (Apr. 1 – June 30) Third (July 1 – Sept. 30) Fourth (Oct. 1 – Dec. 31) Total for year

Liability for quarter

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 ©

Form 940-EZ (1997)

If you will not have to file returns in the future, check here (see Who must file on page 2) and complete and sign the return ©

$

Part I

Part II

Cat. No. 10983G

(99)

Form 940-EZ(V)

Department of the Treasury

Internal Revenue Service

Form 940-EZ Payment Voucher

Enter the amount of the payment you are making Enter the first four letters of your last name

(business name if partnership or corporation)

1 2

4 Enter your name (individual name for sole proprietors)

DETACH HERE

OMB No. 1545-1110

© $ .

Use this voucher only when making a payment with your return.

3 Enter your employer identification number

Enter your address

Enter your city, state, and ZIP code

Complete boxes 1, 2, 3, and 4. Do not send cash, and do not staple your payment to this voucher. Make your check or money order payable to the

Internal Revenue Service. Be sure to enter your employer identification number, “Form 940-EZ,” and “1997” on your payment.

© For Paperwork Reduction Act Notice, see page 4.

Instructions for Box 2

—Individuals (sole proprietors, trusts, and estates)—

Enter the first four letters of your last name.

—Corporations and partnerships—Enter the first four

characters of your business name (omit “The” if

followed by more than one word).

97

97

Applied to next return or Refunded ©
Ä

Form 940-EZ (1997) Page 2

Count all regular, temporary, and part-time employees. A partnership

should not count its partners. If a business changes hands during the

year, each employer meeting test 1 or 2 must file. Do not report wages

paid by the other.

Did you pay

unemployment

contributions to only one

state?

No ©

Household employers. File a FUTA tax return ONLY if you paid total

cash wages of $1,000 or more (for all household employees) in any

calendar quarter in 1996 or 1997 for household work in a private home,

local college club, or local chapter of a college fraternity or sorority.

Individuals, estates, and trusts that owe FUTA tax for household work

in a private home, in most cases must file Schedule H (Form 1040),

Household Employment Taxes, instead of Form 940 or 940-EZ. See the

instructions for Schedule H. In some cases, such as when you employ

both household employees and other employees, you may have the

option to report social security, Medicare, and withheld Federal income

taxes for your household employee(s) on Form 941, Employer’s

Quarterly Federal Tax Return, or 943, Employer’s Annual Tax Return for

Agricultural Employees, instead of on Schedule H. If you choose to

report on Form 941 or 943, you must use Form 940 or 940-EZ to report

FUTA taxes.

Did you pay all state

unemployment

contributions by

January 31?*

No ©

Agricultural employers. File a FUTA tax return if either of the

following tests applies:

Were all wages that were

taxable for FUTA tax also

taxable for your state’s

unemployment tax?

No ©

1. You paid cash wages of $20,000 or more to farmworkers during

any calendar quarter in 1996 or 1997 or

2. You employed 10 or more farmworkers during some part of a day

(whether or not at the same time) for at least 1 day during any 20

different weeks in 1996 or 1997.

Ä

You may use Form

940-EZ.

Who must file. In general, you must file if either of the following tests

applies (household and agricultural employers see below):

1. You paid wages of $1,500 or more in any calendar quarter in 1996

or 1997 or

2. You had one or more employees for some part of a day in any 20

or more different weeks in 1996 or 20 or more different weeks in 1997.

(Instructions continued on next page.)

The following chart will lead you to the right form to use; however, if

you owe FUTA tax only for household work in a private home, you

generally must use Schedule H (see Household employers below).

Yes

Ä

Yes

Ä

Yes

Note: Do not file Form 940-EZ if you have already filed Form 940 for 1997.

Who May Use Form 940-EZ

When to file. File Form 940-EZ for 1997 by February 2, 1998. However,

if you deposited all FUTA tax when due, you may file on or before

February 10, 1998. Your return will be considered timely filed if it is

properly addressed and mailed First Class or sent by an IRS designated

delivery service by the due date. See Cir. E, Employer’s Tax Guide, for

a list of designated delivery services.

You must use Form

940 instead.**

General Instructions

Purpose of form. Use this form to report your annual Federal

Unemployment Tax Act (FUTA) tax. FUTA tax, together with state

unemployment systems, provides for payments of unemployment

compensation to workers who have lost their jobs. Most employers pay

both Federal and state unemployment taxes. Only the employer pays

this tax. The tax applies to the first $7,000 you pay each employee in a

year. The $7,000 amount is the Federal wage base. Your state wage

base may be different.

*If you deposited all FUTA tax when due, you may answer “Yes” if you

paid all state unemployment contributions by February 10.

**To get Form 940 or Schedule H (Form 1040), call 1-800-TAX-FORM

(1-800-829-3676).

If you are a successor employer claiming a credit for state

unemployment contributions paid by the prior employer, you must use

Form 940.

Changes To Note

FUTA rate. The FUTA rate of .008 shown on line 6 is effective through

2007.

Services performed by inmates. Services performed by inmates of a

penal institution in a private-sector job are not subject to FUTA. This

applies to services performed after January 1, 1994. Services for a

government agency performed by inmates of a penal institution

continue to be exempt from FUTA.

Electronic deposit requirements. If your total deposits of social

security, Medicare, railroad retirement, and withheld income taxes were

more than $50,000 in 1996, you must make electronic deposits for all

depository tax liabilities (including FUTA tax) that occur after 1997 using

the Electronic Federal Tax Payment System (EFTPS). However, if you

were first required to use EFTPS on or after July 1, 1997, no penalties

for failure to use EFTPS will be imposed prior to July 1, 1998. To enroll

in EFTPS, call 1-800-945-8400 or 1-800-555-4477. For general

information about EFTPS, call 1-800-829-1040.

Caution: Private delivery services cannot deliver items to P.O. boxes.

Nonprofit organizations. Religious, educational, charitable, etc.,

organizations described in section 501(c)(3) of the Internal Revenue

Code and exempt from tax under section 501(a) are not subject to

FUTA tax and are not required to file.

Count wages paid to aliens admitted on a temporary basis to the

United States to perform farmwork, also known as workers with

“H-2(A)” visas, to see if you meet either test. However, wages paid to

H-2(A) visa workers are not subject to FUTA tax.
Employer’s Annual Federal OMB No. 1545-1110

Unemployment (FUTA) Tax Return Form 940-EZ

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name)

Trade name, if any

Address and ZIP code Employer identification number

Employer’s name, address, and identification number. If you are not

using a preaddressed Form 940-EZ, type or print your name, trade

name, address, and employer identification number (EIN) on the form.

If you do not have an EIN, see Circular E for details on how to make

tax deposits, file a return, etc.

Follow the chart under Who May Use Form 940-EZ on page 2. If you cannot use Form 940-EZ, you must use Form 940 instead.

A Enter the amount of contributions paid to your state unemployment fund. (See instructions for line A on page 4.) ©

B (1) Enter the name of the state where you have to pay contributions ©

(2) Enter your state reporting number as shown on state unemployment tax return ©

If this is an Amended Return, check here ©

Taxable Wages and FUTA Tax

1 Total payments (including payments shown on lines 2 and 3) during the calendar year for services of employees 1

Amount paid

Exempt payments. (Explain all exempt payments, attaching additional sheets

if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the first $7,000

paid to each employee. Do not include any exempt payments from line 2. Do not

use your state wage limitation. The $7,000 amount is the Federal wage base. Your

state wage base may be different

3

3

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

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

6 FUTA tax. Multiply the wages on line 5 by .008 and enter here. (If the result is over $100, also complete Part II.) 6

7 Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records) 7

8 Amount you owe (subtract line 7 from line 6). This should be $100 or less. Pay to “Internal Revenue Service.” © 8

9

Record of Quarterly Federal Unemployment Tax Liability (Do not include state liability.) Complete only if line 6 is over $100.

Quarter First (Jan. 1 – Mar. 31) Second (Apr. 1 – June 30) Third (July 1 – Sept. 30) Fourth (Oct. 1 – Dec. 31) Total for year

Liability for quarter

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 ©

Form 940-EZ (1997)

If you will not have to file returns in the future, check here (see Who must file on page 2) and complete and sign the return ©

$

Part I

Part II

Credit for contributions paid to a state fund. You get a credit for

amounts you pay to a state (including Puerto Rico and the U.S. Virgin

Islands) unemployment fund by February 2, 1998 (or February 10, 1998,

if that is your Form 940-EZ due date).

“Contributions” are payments that a state requires an employer to

make to its unemployment fund for the payment of unemployment

benefits. However, contributions do not include:

● Any payments deducted or deductible from your employees’ pay.

● Penalties, interest, or special administrative taxes not included in the

contribution rate the state assigned to you.

(Instructions continued on next page.)

Not liable for FUTA tax? If you receive Form 940-EZ and are not liable

for FUTA tax for 1997, write “Not Liable” across the front of the form,

sign the return, and return it to the IRS.

Note: If you will not have to file returns in the future, check the box on

the line below B(2), complete and sign the return.

Identifying your payments. When you pay any amount you owe to the

IRS (line 8) or make Federal tax deposits, write the following on your

check or money order: your EIN, “Form 940-EZ,” and the tax year to

which the payment applies. This helps us credit your account properly.

Penalties and interest. Avoid penalties and interest by making tax

deposits when due, filing a correct return, and paying all taxes when

due. There are penalties for late deposits and late filing unless you can

show reasonable cause. If you file late, attach an explanation to the

return. There are also penalties for willful failure to pay tax, keep

records, make returns, and for filing false or fraudulent returns.

(99) © For Paperwork Reduction Act Notice, see page 4.

Calendar year

97

9 Overpayment (subtract line 6 from line 7). Check if it is to be: Applied to next return or Refunded ©

Where to file. In the list below, find the state where your legal

residence, principal place of business, office, or agency is located. Send

your return to the Internal Revenue Service at the address listed for

your location. No street address is needed.

Florida, Georgia, South Carolina

New Jersey, New York (New York City and counties of Nassau, Rockland, Suffolk,

and Westchester)

Holtsville, NY 00501-0047 P.O. Box 210

Newark, NJ 07101-0210

Return without payment: Return with payment:

Atlanta, GA 39901-0047

Return without payment:

P.O. Box 105659

Atlanta, GA 30348-5659

Return with payment:

Note: Where you file depends on whether or not you are including a payment.

● Voluntary contributions you paid to get a lower assigned rate.

Note: Be sure to enter your state reporting number on line B(2) at the

top of the form. The IRS needs this to verify your state contributions.
Form 940-EZ (1997) Page 4

New York (all other counties), Connecticut, Maine, Massachusetts,

New Hampshire, Rhode Island, Vermont

Illinois, Iowa, Minnesota, Missouri, Wisconsin

Delaware, District of Columbia, Maryland, Pennsylvania, Puerto Rico, Virginia,

U.S. Virgin Islands

Philadelphia, PA 19255-0047

Indiana, Kentucky, Michigan, Ohio, West Virginia

Cincinnati, OH 45999-0047

Kansas, New Mexico, Oklahoma, Texas

Alaska, Arizona, California (counties of Alpine, Amador, Butte, Calaveras, Colusa,

Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin,

Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Sacramento, San Joaquin,

Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and

Yuba), Colorado, Idaho, Montana, Nebraska, Nevada, North Dakota, Oregon,

South Dakota, Utah, Washington, Wyoming

Ogden, UT 84201-0047

California (all other counties), Hawaii

Fresno, CA 93888-0047

Alabama, Arkansas, Louisiana, Mississippi, North Carolina, Tennessee

Memphis, TN 37501-0047

If you have no legal residence or principal place of business in any IRS district,

file with the Internal Revenue Service Center, Philadelphia, PA 19255.

How you make the payments is not important to determine if they are

wages. Thus, you may pay wages for piecework or as a percentage of

profits. You may pay wages hourly, daily, etc. You may pay wages in

cash or some other way, such as goods, lodging, food, or clothing. For

items other than cash, use the fair market value when paid.

Line 2—Exempt payments. For FUTA purposes, “wages” and

“employment” do not include every payment and every kind of service

an employee may perform. In general, payments excluded from wages

and payments for services excepted from employment are not subject

to tax. Enter payments such as the following on line 2.

1. Agricultural labor if you did not meet either test under Agricultural

employers on page 2.

2. Benefit payments for sickness or injury under a worker’s

compensation law.

3. Household service if you did not pay total cash wages of $1,000 or

more in any calendar quarter in 1996 or 1997, and you included the

amount on line 1.

4. Certain family employment.

5. Certain fishing activities.

6. Noncash payments for farmwork or household services in a private

home that are included on line 1. Only cash wages to these workers are

taxable.

7. Value of certain meals and lodging.

8. Cost of group-term life insurance.

11. Any other exempt service or pay.

For more information, see Special Rules for Various Types of Services

and Payments in Circular E.

Line 3—Payments for services of more than $7,000. Enter the total

amounts over $7,000 you paid each employee. For example, if you have

10 employees and paid each $8,000 during the year, enter $80,000 on

line 1 and $10,000 on line 3. The $10,000 is the amount over $7,000

paid to each employee. Do not include any exempt payments from line

2 in figuring the $7,000.

Part II. Record of Quarterly Federal Unemployment Tax

Liability

Complete this part only if your FUTA tax on line 6 is over $100. To

figure your FUTA tax liability, multiply by .008 that part of the first

$7,000 of each employee’s annual wages you paid during the quarter.

Enter the result in the space for that quarter. Your total liability must

equal your total tax. If not, you may be charged a failure to deposit

penalty.

Record your liability based on when you pay the wages, not on when

you deposit the tax. For example, if you pay wages on March 29, your

FUTA tax liability on those wages is $200, and you deposit the $200 on

April 30, you would record that $200 in the first quarter, not the second.

Depositing FUTA taxes.—Generally, FUTA taxes must be deposited

quarterly only when your liability exceeds $100. If you deposited the

right amounts, the amount you owe with Form 940-EZ will never be

over $100.

Note: The total amount of all deposits must be shown on line 7.

9. Payments attributable to the employee’s contributions to a

sick-pay plan.

10. Benefits excludable under a section 125 (cafeteria) plan. P.O. Box 8738

Philadelphia, PA 19162-8738

P.O. Box 6796

Chicago, IL 60680-6796

P.O. Box 7028

San Francisco, CA 94120-7028

Return without payment: Return with payment:

P.O. Box 60150

Los Angeles, CA 90060-0150

Return without payment: Return with payment:

P.O. Box 1210

Charlotte, NC 28201-1210

Return without payment:

Return without payment:

Return without payment:

Return with payment:

Return with payment:

Return with payment:

If your FUTA tax liability for any of the first three quarters of 1997

(plus any undeposited amount of $100 or less from any earlier quarter)

is over $100, deposit it by the last day of the month after the end of the

quarter. If it is $100 or less, carry it to the next quarter; a deposit is not

required. If your liability for the fourth quarter (plus any undeposited

amount from any earlier quarter) is over $100, deposit the entire amount

by February 2, 1998. If it is $100 or less, you can either make a deposit

or pay it with your Form 940-EZ.

Andover, MA 05501-0047

Return without payment: Return with payment:

P.O. Box 371324

Pittsburgh, PA 15250-7324

Kansas City, MO 64999-0047

Return without payment: Return with payment:

P.O. Box 970010

St. Louis, MO 63197-0010

Austin, TX 73301-0047 P.O. Box 970017

St. Louis, MO 63197-0017

Return without payment: Return with payment:

Amended returns. Use a new Form 940-EZ to amend a previously filed

Form 940-EZ. Check the Amended Return box above Part I, enter all

amounts that should have been on the original return, and sign the

amended return. Attach an explanation of the reasons for amending the

original return.

If you were required to file Form 940 but filed Form 940-EZ instead,

file the amended return on Form 940. See Form 940 and its instructions.

Specific Instructions

You must complete lines A and B and Part I. If your FUTA tax (line

6) is over $100, you must also complete Part II. Please remember to

sign the return.

Line A. Enter the amount of state unemployment contributions. If your

state has given you a 0% experience rate, so there are no required

contributions, enter “0% rate” in the space.

Part I. Taxable Wages and FUTA Tax

Line 1—Total payments. Enter the total payments you made during the

calendar year for services of employees, even if the payments are not

taxable for FUTA tax. Include salaries, wages, commissions, fees,

bonuses, vacation allowances, amounts paid to temporary or part-time

employees, and the value of goods, lodging, food, clothing, and

noncash fringe benefits, contributions to a 401(k) plan, section 125

(cafeteria) plan benefits, and sick pay (including third party if liability

transferred to employer). Also, include tips of $20 or more in a month

reported to you by your employees. Enter the amount before any

deductions.

If you are not required to use EFTPS, use Form 8109, Federal Tax

Deposit Coupon, to deposit FUTA tax in an authorized financial

institution or the Federal Reserve bank for your area. Records of your

deposits will be sent to the IRS for crediting to your business accounts.

If your total deposits of social security, Medicare, railroad retirement,

and withheld income taxes exceeded $50,000 in 1996, you must

deposit taxes after 1997 using the Electronic Federal Tax Payment

System (EFTPS). See Changes To Note on page 2.

Paperwork Reduction Act Notice.—We ask for the information on this

form to carry out the Internal Revenue laws of the United States. You

are required to give us the information. We need it to ensure that you

are complying with these laws and to allow us to figure and collect the

right amount of tax.

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 or records relating to a form or its

instructions must be retained as long as their contents may become

material in the administration of any Internal Revenue law. Generally, tax

returns and return information are confidential, as required by Code

section 6103.

If you have comments concerning the accuracy of these time

estimates or suggestions for making this form simpler, we would be

happy to hear from you. You can write to the Tax Forms Committee,

Western Area Distribution Center, Rancho Cordova, CA 95743-0001.

DO NOT send the form to this office. Instead, see Where to file on

page 3.

The time needed to complete and file this form will vary depending on

individual circumstances. Estimated average time is: Recordkeeping—6

hr., 23 min., Learning about the law or form—7 min., and Preparing

and sending the form to the IRS—34 min.

Lines 8 and 9.—If the amount on line 8 is under $1, you do not have to

pay it. If the amount on line 9 is under $1, we will send a refund or

apply it to your next return only on written request.