Additional tax resulting from credit reduction for unrepaid advances to the State of New York.

Enter the wages included on line 5 for New York and multiply by .003. (See the separate

Instructions for Form 940.) Enter the credit reduction amount here and in Part II, line 5:

New York wages x .003 = 

OMB No. 1545-0028 Employer’s Annual Federal 940 Unemployment (FUTA) Tax Return Form

Department of the Treasury

Internal Revenue Service  See the separate Instructions for Form 940 for information on completing this form.

Yes No

If you will not have to file returns in the future, check here (see Who Must File in the separate instructions) and

complete and sign the return 

Computation of Taxable Wages

1

Total payments (including payments shown on lines 2 and 3) during the calendar year for

services of employees

1

Exempt payments. (Explain all exempt payments, attaching additional

sheets if necessary.) 

2

2

Payments of more than $7,000 for services. Enter only amounts over the first $7,000

paid to each employee (see separate instructions). Do not include any exempt

payments from line 2. The $7,000 amount is the federal wage base. Your state wage

base may be different. Do not use your state wage limitation

3

3

4 Add lines 2 and 3 4

5 Total taxable wages (subtract line 4 from line 1)  5

Form 940 (2004)

Part I

If this is an Amended Return, check here (see Amended Returns in the separate instructions) 

A Are you required to pay unemployment contributions to only one state? (If “No,” skip questions B and C.)

B

C

Be sure to complete both sides of this form, and sign in the space provided on the back.

Calendar year

Trade name, if any

Address (number and street) City, state, and ZIP code

Did you pay all state unemployment contributions by January 31, 2005? ((1) If you deposited your total FUTA

tax when due, check “Yes” if you paid all state unemployment contributions by February 10, 2005. (2) If a 0%

experience rate is granted, check “Yes.” (3) If “No,” skip question C.)

Were all wages that were taxable for FUTA tax also taxable for your state’s unemployment tax?

If you answered “No” to any of these questions, you must file Form 940. If you answered “Yes” to all the

questions, you may file Form 940-EZ, which is a simplified version of Form 940. (Successor employers, see

Special credit for successor employers in the separate instructions.) You can get Form 940-EZ by calling

1-800-TAX-FORM (1-800-829-3676) or from the IRS website at www.irs.gov.

Yes No

Yes No

Cat. No. 11234O

Form 940-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

DETACH HERE

OMB No. 1545-0028

Use this voucher only when making a payment with your return.

Complete boxes 1, 2, and 3. 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 940,” and “2004” on your payment.

(99)

1 2

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

Enter your address.

Enter your city, state, and ZIP code.

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

Enter your employer identification number (EIN).

Enter the amount of your payment. 

Dollars



You must

complete

this section.



Cents

Employer identification number (EIN)

2004

2004

T

I

FP

FD

FF

T

6

6

Name (as distinguished from trade name)

D Did you pay all wages in a state other than New York? Yes No
Tax Due or Refund

1 Gross FUTA tax. (Multiply the wages from Part l, line 5, by .062) 1

2 Maximum credit. (Multiply the wages from Part l, line 5, by .054) 2

3

Total FUTA tax (subtract line 6 from line 1). If the result is over $100, also complete Part III

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

5

Balance due (subtract line 8 from line 7). Pay to the “United States Treasury.” If you owe more

than $100, see Depositing FUTA Tax on page 3 of the separate instructions 

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 Unemployment Tax Liability (Do not include state liability.) Complete only if

line 7 is over $100. See page 7 of the separate instructions.

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

(a)

Name

of

state

(i)

Contributions

paid to state by

940 due date

(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 period

From To

Totals 

Total tentative credit (add line 3a, columns (h) and (i) only—for late payments, also see the

instructions for Part II, line 4) 

Form 940 (2004) Page 2

Part III

Computation of tentative credit (Note: All taxpayers must complete the applicable columns.)

3a

3b

4

9

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 

8

9

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

10

10

Part II

6

Form 940 (2004)

3b

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

Credit: Enter the smaller of the amount from Part II, line 2 or line 3b; or the amount from the

worksheet on page 7 of the separate instructions 4

Enter the amount from Part I, line 6 5

Name Employer identification number (EIN)