OMB No. 1545-0035 Employer’s Annual Federal Tax Return for Agricultural Employees Form 943

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name) Calendar year

Trade name, if any Employer identification number (EIN) 

Address (number and street) If address is different

from prior return,

check here 

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

 See the separate Instructions for Form 943 for information on completing this return.

1 Number of agricultural employees employed in the pay period that includes March 12, 2004  1

2 2

3 Social security tax (multiply line 2 by 12.4% (.124)) 3

4 Total wages subject to Medicare tax (see separate instructions) 4

5 Medicare tax (multiply line 4 by 2.9% (.029)) 5

6 Federal income tax withheld (see separate instructions) 6

7 Total taxes before adjustments (add lines 3, 5, and 6) 7

8

Advance earned income credit (EIC) payments made to employees, if any (see separate instructions)

8

9

Net taxes (subtract line 10 from line 9)

9

10

Total deposits for 2004, including overpayment applied from 2003 return

10

Balance due (subtract line 12 from line 11). (see separate instructions) 

11

13

14 Overpayment. If line 12 is more than line 11, enter here  $ and check if to be: Applied to next return or Refunded.

● All filers: If line 11 is less than $2,500, do not complete line 15 or Form 943-A.

Tax liability for month

A January

B

C

D

E

F

G

H

I

J

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 

Total wages subject to social security tax (see separate instructions)

Adjustment to taxes (see separate instructions)

Total taxes (line 7 as adjusted by line 8)

12

13

11

12

February

March

April

May

June

July

August

September

October

Tax liability for month Tax liability for month

Total liability for

year (add lines A

through L)

M

November

December

Form 943-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

Do not send cash and do not staple your payment to this voucher. Make your check or money order payable to the “United States Treasury.” Be sure

to enter your employer identification number (EIN), “Form 943,” and “2004” on your payment.

 DETACH HERE 

● Semiweekly schedule depositors: Complete Form 943-A and check here  ● Monthly schedule depositors: Complete line 15 and check here 

15 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)

 Use this voucher when making a payment with your return.

K

L

Sign

Here

Cat. No. 11252K

1 Enter your employer identification number (EIN). Dollars

3 Enter your business name (individual name for sole proprietors).

Enter your address.

Enter your city, state, and ZIP code.

Form 943 (2004)

Designee’s

name 

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

Party

Designee Phone

no. 

Personal identification

( ) number (PIN) 

Yes. Complete the following. No.

Enter the amount of your payment. 

2 Cents

City, state, and ZIP code

Enter state code

for state in which

deposits were

made only if

different from

state in address

to the right 

(see the separate

instructions).

2004

2004

T

FF

FD

FP

I

T

If you do not have

to file returns in the

future, check

here 
Purpose of Form

Complete Form 943-V if you are making a payment

with Form 943, Employer’s Annual Federal Tax Return

for Agricultural Employees. We will use the completed

voucher to credit your payment more promptly and

accurately, and to improve our service to you.

Otherwise, you must deposit the amount at an

authorized financial institution or by electronic funds

transfer. (See section 7 of Pub. 51 (Circular A) for

deposit instructions.) Do not use the Form 943-V

payment voucher to make federal tax deposits.

Specific Instructions

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.

● Enclose your check or money order made payable to

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

your EIN, “Form 943,” 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 943 to the address provided in the

separate Instructions for Form 943.

Instructions for Form 943-V

Payment Voucher

Make a payment with your 2004 Form 943 only if:

Making Payment With Form 943

● Your net taxes for the year (line 11 on Form 943) are

less than $2,500 and the taxes are paid 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 7 of Pub. 51 (Circular A), Agricultural

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

be $2,500 or more.

Caution. If you pay an amount with Form 943 that

should have been deposited, you may be subject to a

penalty. See Deposit Penalties in section 7 of

Pub. 51 (Circular A).

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.

Note. You must also complete the entity information

above line 1 on Form 943.

Box 2—Amount paid. Enter the amount paid with

Form 943.

Box 3—Name and address. Enter your business

name and address as shown on Form 943.