OMB No. 1545-1110

Employer’s Annual Federal

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: Applied to next return, or Refunded © 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 (1995)

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 characters of your

business name

1 2

4 Enter your name

DETACH HERE

OMB No. 1545-1110

© $ .

For Paperwork Reduction Act Notice, see instructions.

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, with your

employer identification number written on it, payable to the Internal Revenue Service.

Do not staple your payment to this voucher.
Ä

Form 940-EZ (1995) 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.

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 correct tax.

Did you pay

unemployment

contributions to only one

state?

No ©

Household Employers.—File a FUTA tax return ONLY if you paid

cash wages of $1,000 or more in any calendar quarter in 1994 or

1995 for household work in a private home, local college club, or a

local chapter of a college fraternity or sorority. Individuals, estates,

and trusts that owe FUTA tax for domestic service 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 Form 943, Employer’s

Annual Tax Return for Agricultural Employees, instead of on

Schedule H. If you choose to report on Form 941 or Form 943, you

must use Form 940 or Form 940-EZ to report FUTA taxes.

The time needed to complete and file this form will vary

depending on individual circumstances. Estimated average time is:

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?

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. Write to the Western Area Distribution

Center, Attention: Tax Forms Committee, Rancho Cordova, CA

95743-0001. DO NOT send the form to this office. Instead, see

Where To File on page 4.

No ©

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

during any calendar quarter in 1994 or 1995; 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 1994 or 1995.

Ä

You may use Form

940-EZ.

Count 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. Wages paid to these aliens are subject

to FUTA tax after 1994.

Who Must File.—The General Rule (household and agricultural

employers see below) states you must file if either of the following

tests applies:

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

1994 or 1995; or

2. You had at least one employee for some part of a day in any

20 different weeks in 1994 or 1995.

(Instructions continued on next page.)

The following chart will lead you to the right form to use.

Were all wages paid in a

state other than a credit

reduction state?* No ©

Yes

Ä

Yes

Ä

Yes

Ä

Yes

*

Note: Do not file Form 940-EZ if you have already filed Form 940 for 1995.

Who May Use Form 940-EZ

When To File.—Form 940-EZ for 1995 is due by January 31, 1996.

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

or before February 12, 1996.

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

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.

**

Contact your state unemployment insurance office for credit

reduction state information.

If you need to file Form 940, you can get the form by calling

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

Recordkeeping—6 hr., 23 min., Learning about the law or form—

7 min., and Preparing and sending the form to the IRS—34 min.

each employee in a year. The $7,000 amount is the Federal wage

base. Your state wage base may be different.
OMB No. 1545-1110

Employer’s Annual Federal

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 Form 940-EZ.

See Circular E, Employer’s Tax Guide, for details on how to make

tax deposits, file a return, etc., if these are due before you get your

EIN.

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: Applied to next return, or Refunded © 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 (1995)

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

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.

Credit for Contributions Paid Into State Funds.—You get a credit

for amounts you pay to a state (including Puerto Rico)

unemployment fund by January 31. This credit is reflected in the

FUTA tax rate (.008) on line 6. The rate is effective through 1998.

“Contributions” are payments that a state requires you, as 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.

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

(Instructions continued on next page.)

Completing Form 940-EZ.—If your FUTA tax for 1995 (line 6) is

$100 or less, complete only Part I of the form. If your FUTA tax is

over $100, complete Parts I and II. See the instructions for Part II

for information on FUTA tax deposits.

Not Liable for FUTA Tax?—If you receive Form 940-EZ and are

not liable for FUTA tax for 1995, 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 period 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

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

the top of the form. We need this to verify your state contributions.

Credit for Successor Employers.—If you are claiming credit as a

successor employer, you must use Form 940.

(99)
Form 940-EZ (1995) Page 4

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

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, weekly,

monthly, or yearly. 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 that are

not wages and payments for services that are not 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 in 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 cash wages of $1,000 or

more in any calendar quarter in 1994 or 1995, 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 Products in Circular E.

Line 3—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 by April 30, you would record that $200 in the first

quarter, not the second.

Depositing FUTA Taxes.—Generally, FUTA taxes are deposited

quarterly. If you deposited the right amounts, following these rules,

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.

Using Form 8109, Federal Tax Deposit Coupon, 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.

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

sick-pay plan.

10. Benefits excludable under a section 125 plan (cafeteria plan).

Printed on recycled paper

P.O. Box 210

Newark, NJ 07101-0210

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 without payment:

Return with payment:

Return with payment:

Return with payment:

Return with payment:

If your liability for any of the first three quarters of 1995 (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 January 31, 1996. If it is $100 or less, you can

either make a deposit or pay it with your Form 940-EZ by January

31.

Atlanta, GA 39901-0047

Return without payment:

P.O. Box 105659

Atlanta, GA 30348-5659

Return with payment:

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:

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

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 the 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 to

employees during the calendar year, even if they 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,

noncash fringe benefits, and contributions to a 401(k) pension plan.

Also, include the amount of tips reported to you in writing by your

employees. Enter the amount before any deductions.