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US Internal Revenue Service: f941 - 2005
US Internal Revenue Service: f941 - 2005
US Internal Revenue Service: f941 - 2005
VERSION B
9901
Form 941 for 2005: Employer’s Quarterly Federal Tax Return
Department of the Treasury — Internal Revenue Service
(Rev. January 2005) OMB No. 1545-0029
—
Employer identification number Report for this Quarter ...
(Check one.)
Read the separate instructions before you fill out this form. Please type or print within the boxes.
Part 1: Answer these questions for this quarter.
1 Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), Dec. 12 (Quarter 4) 1
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 17001Z Form 941 (Rev. 1-2005)
OTC 12
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 941, PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄2 ") CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 279 mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
VERSION B
9902
You were a monthly schedule depositor for the entire quarter. Fill out your tax
liability for each month. Then go to Part 3.
Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.
16 If your business has closed and you do not have to file returns in the future Check here, and
17 If you are a seasonal employer and you do not have to file a return for every quarter of the year Check here.
No.
✗
the best of my knowledge and belief, it is true, correct, and complete.
Date / / Phone ( ) –
Preparer’s signature
Firm’s name
Address EIN
ZIP code
VERSION B
Form 941-V,
Payment Voucher
Detach Here and Mail With Your Payment and Tax Return. Form 941-V (2005)
941-V
OMB No. 1545-0029
Payment Voucher
Form
3 Tax period 4 Enter your business name (individual name if sole proprietor).
1st 3rd
Quarter Quarter Enter your address.
VERSION B
Privacy Act and Paperwork Reduction Act Notice. information to other countries under a tax treaty, to
We ask for the information on this form to carry out the federal and state agencies to enforce federal nontax
Internal Revenue laws of the United States. We need it criminal laws, or to federal law enforcement and
to figure and collect the right amount of tax. Subtitle C, intelligence agencies to combat terrorism.
Employment Taxes, of the Internal Revenue Code
imposes employment taxes on wages, including The time needed to complete and file this form will
income tax withholding. This form is used to determine vary depending on individual circumstances. The
the amount of the taxes that you owe. Section 6011 estimated average time is:
requires you to provide the requested information if the For Form 941:
tax is applicable to you. Section 6109 requires you to Recordkeeping 12 hr., 39 min.
provide your employer identification number (EIN). If
Learning about the law or the form 40 min.
you fail to provide this information in a timely manner,
you may be subject to penalties and interest. Preparing the form 1 hr., 49 min.
Copying, assembling, and sending
You are not required to provide the information the form to the IRS 16 min.
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB For Form 941TeleFile:
control number. Books and records relating to a form Recordkeeping 5 hr., 30 min.
or instructions must be retained as long as their Learning about the law or the Tax
contents may become material in the administration of Record 18 min.
any Internal Revenue law. Preparing the Tax Record 24 min.
Generally, tax returns and return information are TeleFile phone call 11 min.
confidential, as required by section 6103. However, If you have comments concerning the accuracy of
section 6103 allows or requires the IRS to disclose or these time estimates or suggestions for making this
give the information shown on your tax return to others form simpler, we would be happy to hear from you.
as described in the Code. For example, we may You can write to: Internal Revenue Service, Tax
disclose your tax information to the Department of Products Coordinating Committee,
Justice for civil and criminal litigation, and to cities, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,
states, and the District of Columbia for use in IR-6406, Washington, DC 20224. Do not send Form
administering their tax laws. We may also disclose this 941 to this address.