Version D

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.

T

Name (as distinguished from trade name) Calendar year FF

FD If incorrect,

make any

necessary

change.

Trade name, if any FP

I

Address and ZIP code Employer identification number T

–

Did you pay all required contributions to state unemployment funds by the due date of Form 940? (If a 0%

experience rate is granted, check “Yes” and see instructions.)

A

Yes No

If you checked the “Yes” box, enter the amount of contributions paid to state unemployment funds © $

B Are you required to pay contributions to only one state?

If you checked the “Yes” box: (1) Enter the name of the state where you have to pay contributions ©

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

If any part of wages taxable for FUTA tax is exempt from state unemployment tax, check the box. (See the

instructions.)

C

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

Computation of Taxable Wages (to be completed by all taxpayers)

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 the amounts

over the first $7,000 paid to each employee. Do not include payments

from line 2. 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 (1991)

©

Part I

Yes No

If this is an Amended Return, check here ©

Cat. No. 11234O

940-V

(Rev. January 1991)

Department of the Treasury

Internal Revenue Service

1991 Form 940 Payment Voucher

(If any of the preprinted information is incorrect, make the changes on Form 940, not on the payment voucher.)

● Make check or money order payable to the

Internal Revenue Service. Do not send cash.

Form

● Include but do not staple your payment with this return.

Form 940-V (1991)

DO NOT DETACH

If you checked the “No” box, be sure to complete Part III and see the instructions.

● If payment is over $100 you must deposit the

amount due.

Additional tax resulting from credit reduction for unrepaid advances to the state of Michigan. Enter

the wages included on line 5 above for that state and multiply by the rate shown. (See the instructions.) Enter the credit reduction amount here and in Part II, line 2, or Part III, line 5:

Michigan wages 3 .008 = ©

6

6
Tax Due or Refund ( Complete if you checked the “Yes” boxes in both questions A and B and did not check

the box in C. )

1 FUTA tax. Multiply the wages in Part l, line 5, by .008 and enter here 1

2

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

3

Balance due (subtract line 4 from line 3). This should be $100 or less. Pay to the Internal Revenue

Service ©

5

4

Overpayment (subtract line 3 from line 4). Check if it is to be: Applied to next return,

or Refunded ©

6

Tax Due or Refund ( Complete if you checked the “No” box in either question A or B or you checked the box in C. )

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

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

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 ©

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 Tax Liability for Unemployment Tax (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

the 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

From To

Totals ©

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

Form 940 (1991) Page 2

Part IV

Part III

Part II

Computation of tentative credit

3a

3b

4

9

4

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 ©

2 Enter amount from Part I, line 6 

3 Total FUTA tax (add lines 1 and 2) ©

5

6

Enter the amount from Part I, line 6 

8

5

9

Credit allowable (subtract line 5 from line 4). (If zero or less, enter 0.)

10

10
Employer identification number

–

Version D

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.

Did you pay all required contributions to state unemployment funds by the due date of Form 940? (If a 0%

experience rate is granted, check “Yes” and see instructions.)

A

Yes No

If you checked the “Yes” box, enter the amount of contributions paid to state unemployment funds © $

B Are you required to pay contributions to only one state?

If you checked the “Yes” box: (1) Enter the name of the state where you have to pay contributions ©

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

C

Yes No

If you checked the “No” box, be sure to complete Part III and see the instructions.

If any part of wages taxable for FUTA tax is exempt from state unemployment tax, check the box. (See the

instructions.)

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

Computation of Taxable Wages (to be completed by all taxpayers)

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 the amounts

over the first $7,000 paid to each employee. Do not include payments

from line 2. 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 (1991)

Part I

If this is an Amended Return, check here ©

Additional tax resulting from credit reduction for unrepaid advances to the state of Michigan. Enter

the wages included on line 5 above for that state and multiply by the rate shown. (See the instructions.) Enter the credit reduction amount here and in Part II, line 2, or Part III, line 5:

Michigan wages 3 .008 = ©

6

6
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. 937,

Business Reporting, for more information. Household employers should see Pub. 926, Employment Taxes for Household Employers.

Page 4

Tax Due or Refund ( Complete if you checked the “Yes” boxes in both questions A and B and did not check

the box in C. )

1 FUTA tax. Multiply the wages in Part l, line 5, by .008 and enter here 1

2

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

3

Balance due (subtract line 4 from line 3). This should be $100 or less. Pay to the Internal Revenue

Service ©

5

4

Overpayment (subtract line 3 from line 4). Check if it is to be: Applied to next return,

or Refunded ©

6

Tax Due or Refund ( Complete if you checked the “No” box in either question A or B or you checked the box in C. )

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

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

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 ©

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 Tax Liability for Unemployment Tax (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

the 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

From To

Totals ©

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

Form 940 (1991)

Part IV

Part III

Part II

Computation of tentative credit

3a

3b

4

9

4

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 ©

2 Enter amount from Part I, line 6 

3 Total FUTA tax (add lines 1 and 2) ©

5

6

Enter the amount from Part I, line 6 

8

5

9

Credit allowable (subtract line 5 from line 4). (If zero or less, enter 0.)

10

10