Form 941-M Employer's Monthly Federal Tax Return

941-M for 2008:

Form
(Rev. January 2008)

Employer’s MONTHLY Federal Tax Return

© Do not file this form unless instructed to do so by the IRS.

Department of the Treasury — Internal Revenue Service

(EIN)
Employer identification number

OMB No. 1545-0718

Report for this Month of 2008

—

(Check ONE month only.)

Name (not your trade name)

Jan.

Feb.

March

Trade name (if any)

April

May

June

July

August

Sept.

Oct.

Nov.

Dec.

Address

Number

Street

Suite or room number

City

State

ZIP code

Read the separate instructions before you complete this form. Type or print within the boxes.

Part 1: Answer these questions for this month.
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

2 Wages, tips, and other compensation

2

3 Total income tax withheld from wages, tips, and other compensation

3

4 If no wages, tips, and other compensation are subject to social security or Medicare tax
5 Taxable social security and Medicare wages and tips:
Column 1
5a Taxable social security wages
5b Taxable social security tips
5c Taxable Medicare wages & tips

.
.
.

Column 2
3 .124 =
3 .124 =
3 .029 =

6

7 TAX ADJUSTMENTS (Read the instructions for line 7 before completing lines 7a through 7g.):

7c Current month’s adjustments for tips and group-term life insurance
7d Current year’s income tax withholding (attach Form 941c)
7e Prior months’ social security and Medicare taxes (attach Form 941c)
7f Special additions to federal income tax (attach Form 941c)
7g Special additions to social security and Medicare (attach Form 941c)

.
.

5d

6 Total taxes before adjustments (lines 3 + 5d = line 6)

7b Current month’s sick pay

Check and go to line 6.

.
.
.

5d Total social security and Medicare taxes (Column 2, lines 5a + 5b + 5c = line 5d)

7a Current month’s fractions of cents

.
.

.
.
.
.
.
.
.
.
.
.
.
.
.

7h

7h TOTAL ADJUSTMENTS (Combine all amounts: lines 7a through 7g.)
8 Total taxes after adjustments (Combine lines 6 and 7h.)

8

9 Advance earned income credit (EIC) payments made to employees

9

10 Total taxes after adjustment for advance EIC (line 8 – line 9 = line 10)

10

11 Total deposits for this month. Enter the amount from page 2, line 14b

11

12 Balance due (If line 10 is more than line 11, write the difference here.) Make your check or money
12
order payable to United States Treasury
13 Overpayment (If line 11 is more than line 10, write the difference here.)
©

.

Check one

Apply to next return.
Send a refund.

You MUST complete both pages of Form 941-M and SIGN it.

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

Next ©
Cat. No. 17013R

Form

941-M

(Rev. 1-2008)

Name (not your trade name)

Employer identification number (EIN)

Part 2: Tell us about your tax liability and deposits for this month.
14

Record of Federal Tax Liability and Deposits (Read the instructions for this line.)
Tax Liability

Overpayment from
previous month

Amount Deposited

Tax Liability

Amount Deposited

Tax Liability

©

1

12

23

2

13

24

3

14

25

4

15

26

5

16

27

6

17

28

7

18

29

8

19

30
31

9

20

10

21

11

22

a Total tax liability for the month (must equal line 10 on page 1). Add lines 1-31 in
the Tax Liability columns

14a

b Total deposits for the month. Add lines 1-31 (including overpayment from previous
month) in the Amount Deposited columns

14b

15

Amount Deposited

Copy the amount shown on line 14b to line 11.

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 or you stopped paying wages
enter the final date you paid wages

17

/

/

Check here, and

.

If you are a seasonal employer and you do not have to file a return for every month of the year

Check here.

Part 4: May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the
instructions for details.
(

Yes. Designee’s name and phone number

)

–

Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS.
No.

Part 5: Sign here. You MUST complete both pages of Form 941-M and SIGN it.

✗

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
Sign your
name here
name here
Print your
title here
Date

/

/

Best daytime phone

(

)

–

Part 6: For PAID preparers only (optional)
Paid preparer’s
signature
Firm’s name
Address

EIN
ZIP code

Date

/

/

Phone (

)

–

SSN/PTIN

Check if you are self-employed.
Page

2

Form

941-M

(Rev. 1-2008)