Annual Return of Withheld Federal Income Tax

Form 945

Department of the Treasury

Internal Revenue Service Please type or print.

Employer identification number (EIN)

Name (as distinguished from trade name)

Trade name, if any

Address (number and street)

1 Federal income tax withheld from pensions, annuities, IRAs, gambling winnings, etc. 1

2 Backup withholding 2

 See separate instructions. For more information on income tax withholding, see Pub. 15 (Circ. E) and Pub. 15-A.

OMB No. 1545-1430

3

4

5

3

4

5

Total taxes. If $2,500 or more, this must equal line 8M below or line M of Form 945-A

Total deposits for 2004 from your records, including overpayment applied from 2003 return

6 Balance due (subtract line 5 from line 4) (see the instructions)

Overpayment. If line 4 is less than line 5, enter overpayment here  $ and check if to be:

Applied to next return or

Monthly Summary of Federal Tax Liability. (Complete Form 945-A instead, if you were a semiweekly schedule depositor.)

Tax liability for month

A January 

B

C

D

E

F

G

H

I

J

K

L

Total liability for

year (add lines A

through L)

M

February

March 

April 

May 

June 

July

August

September 

October 

November

December

Tax liability for month Tax liability for month

For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Cat. No. 14584B Form 945 (2004)

City, state, and ZIP code

8

Enter state code

for state in

which deposits

were made only

if different from

state in address

to the right 

(see the

instructions).

Printed on recycled paper

● Monthly schedule depositors: Complete line 8, entries A through M, and check here if line 4 is $2,500 or more 

● Semiweekly schedule depositors: Complete Form 945-A and check here if line 4 is $2,500 or more 

● All filers: If line 4 is less than $2,500, do not complete line 8 or Form 945-A.

 For withholding reported on Forms 1099 and W-2G.

Adjustment to correct administrative errors (see the instructions)

6

7

A and enter date final payments made. 

Designee’s

name 

Do you want to allow another person to discuss this return with the IRS (see the instructions)? ThirdParty

Designee Phone

no.  ( )

Yes. Complete the following. No

Personal identification

number (PIN) 

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge Sign and belief, it is true, correct, and complete.

Here Print Your

Signature  Name and Title  Date 

Refunded.

If you do not have to file returns in the future, check here 

2004

Calendar year

IRS USE ONLY

T

FF

FD

FP

I

T

If address is

different

from prior

return, check

here. 

IRS Use

1 1 1 1 1 1 1 1 1 2 3 3 3 3 3 3 4 4 4

6 9 7 8 8 8 8 9 9 10 10 10 10 10 10 10 10 10 10

1 3 3 555

8 9 8 8 8
Purpose of Form

Complete Form 945-V if you are making a payment

with Form 945, Annual Return of Withheld Federal

Income Tax. We will use the completed voucher to

credit your payment more promptly and accurately,

and to improve our service to you.

Otherwise, you are required to deposit the amount at

an authorized financial institution or by electronic funds

transfer. See section 11 of Pub. 15 (Circular E) for

deposit instructions. Do not use the Form 945-V

payment voucher to make federal tax deposits.

Form 945-V

Payment Voucher

Make a payment with your 2004 Form 945 only if:

Making Payments With Form 945

● Your total taxes for the year (line 4 on Form 945) 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 11 of Pub. 15 (Circular E),

Employer’s Tax Guide, for details. This amount may be

$2,500 or more.

Caution: If you pay amounts with Form 945 that

should have been deposited, you may be subject to

a penalty. See Deposit Penalties in section 11 of

Pub. 15 (Circular E).

Specific Instructions

● Enclose your check or money order made payable to

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

EIN, “Form 945,” and “2004” on your check or money

order. Do not send cash. Do not staple this voucher or

your payment to the return (or to each other).

● Detach the completed voucher and send it with your

payment and Form 945 to the address provided in the

Instructions for Form 945.

Form 945-V

Department of the Treasury

Internal Revenue Service

Payment Voucher OMB No. 1545-1430

Box 2—Amount paid. Enter the amount paid with

Form 945.

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.

Box 3—Name and address. Enter your business

name and address as shown on Form 945.

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.

Use this voucher when making a payment with Form 945.

Dollars Cents

If you have your return prepared by a third party and

make a payment with that return, please provide this

payment voucher to the return preparer.

 Detach Here and Mail With Your Payment and Form 945. 

2004

Note: You must also complete the entity information

above line A on Form 945.