Annual Return of Withheld Federal Income Tax

Form 945

Department of the Treasury

Internal Revenue Service Please type or print.

IRS USE ONLY

Name (as distinguished from trade name) Employer identification number T

Trade name, if any

FF

FD

Address (number and street)

FP

I

T

If address is

different

from prior

return, check

here ©

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 Circular E.

OMB No. 1545-1430

3

4

5

3

4

5

Total taxes. This must equal line 8M below or line M of Form 945-A

Total deposits for 1995 from your records

6 Balance due (subtract line 5 from line 4). See instructions

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

Applied to next return OR Refunded

Monthly Summary of Federal Tax Liability

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

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.

Print Your

Signature © Name and Title © Date ©

February

March 

April 

May 

June 

July

August

September 

October 

November

December

Tax liability for month Tax liability for month

Sign

Here

For Paperwork Reduction Act Notice and instructions for completing this form, see separate instructions. Cat. No. 14584B Form 945 (Rev. 10-95)

City, state, and ZIP code

8

Enter state

code for

state in

which

deposits

made ©

(see page 2

of

instructions).

IRS Use

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

5 8 5 5 6 7 8 8 8 8 8 9 9 10 10 10 10 10 10 10 10 10 10

1

4545

Printed on recycled paper

● Monthly schedule depositors: Complete line 8, entries A through M, and check here ©

● Semiweekly schedule depositors: Complete Form 945-A and check here ©

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

© For withholding reported on Forms 1099 and W-2G. (Rev. October 1995)

Adjustment to correct administrative errors (see instructions)

6

7

If you do not have to file returns in the future, check here © and enter date final payments paid ©

Why a payment voucher?

We will credit your payment more promptly and

accurately, and improve our service to you if you use

Form 945-V to make a payment with Form 945,

Annual Return of Withheld Federal Income Tax.

Otherwise, you are required to deposit the amount at

an authorized financial institution (see section 11 of

Circular E for deposit instructions). Make your deposit

with a Federal Tax Deposit (FTD) coupon (Form 8109),

not the Form 945-V payment voucher.

Form 945-V

Department of the Treasury

Internal Revenue Service

Form 945 Payment Voucher OMB No. 1545-1430

(Detach at this line) Cat. No. 20563G

Form 945-V

Payment Voucher

Make payments with Form 945 only if:

When am I permitted to make payments

with Form 945?

1. Your net taxes for the year (line 4 on Form 945)

are less than $500, or

2. You are a monthly schedule depositor making a

payment in accordance with the Accuracy of

Deposits rule (refer to section 11 of Circular E,

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

exceed $500.

Caution: If you pay amounts with Form 945 that

should have been deposited, you may be subject to a

penalty. See Circular E.

Specific Instructions

Box 1—Amount paid.—Enter the amount paid with

Form 945.

Box 2.—Enter the first four characters (letters or

numbers) of your business name (as shown in box 4).

Box 3—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 4—Name and address.—Enter your business

name and address as shown on Form 945.

● Make your check or money order payable to the

Internal Revenue Service, not the IRS. Don’t send

cash. Please don’t staple your payment to the voucher

or the return.

● Detach the voucher and send it with the return.

12 3

4

Enter the amount of the payment you

are making

$ .

Enter the first four characters of your

business name

Enter your employer identification number

Enter your business name

Enter your address

Enter your city, state, and ZIP code

©

For Paperwork Reduction Act Notice, see Form 945 Instructions.