Form 945-X Adjusted Annual Return of Withheld Federal Income Tax or

Form 945-X:
(January 2009)

Draft 11: 11/11/08

Adjusted Annual Return of Withheld Federal Income Tax or Claim for Refund
Department of the Treasury — Internal Revenue Service

OMB No. 1545-1430

Return You Are Correcting …
–

Employer Identification Number (EIN)

Enter the calendar year of the return you
are correcting:

Name (not your trade name)

(YYYY)

Trade name (if any)
Address

Enter the date you discovered errors:
Number

Street

Suite or room number

/
City

State

/

(MM / DD / YYYY)

ZIP code

x
Use this form to correct errors made on Form 945, Annual Return of Withheld Federal Income Tax, for one calendar year only. Please type or
print within the boxes. Do not attach this form to Form 945.

You MUST complete both pages. Read the instructions before you complete this form.
Part 1: Select ONLY one process.

1. Adjusted return of withheld federal income tax. Check this box if you underreported amounts. Also check this box if you overreported
amounts and would like to use the adjustment process to correct the errors. You must check this box if you are correcting both underreported
and overreported amounts on this form. The amount shown on line 5, if less than 0, may only be applied as a credit to your Form 945 for the
tax period in which you are filing this form.
2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement for the
amount shown on line 5. Do not check this box if you are correcting ANY underreported amounts on this form.
Part 2: Enter the corrections for this year. If any line does not apply, leave it blank.

Column 1

Column 2

Total corrected amount
(For ALL payees)

3. Federal income tax withheld
(from line 1 of Form 945)

4. Backup withholding
(from line 2 of Form 945)

.
.

–

Column 3

Amount originally
Difference
reported or as previously
= (If this amount is a
corrected
negative number, use a
(For ALL payees)
minus sign.)

–

–

.
.

=

=

5. Total: Combine the amounts on lines 3 and 4 of Column 3. .....................................................

.
.

.

If line 5 is less than 0…
• If you checked line 1, this is the amount you want applied as a credit to your Form 945 for the tax period in which you are filing this form.
• If you checked line 2, this is the amount you want refunded or abated.

If line 5 is more than 0, this is the amount you owe. Pay this amount when you file this return. Go to Amount You Owe on page x of the instructions.
Next ·

For Paperwork Reduction Act Notice, see the instructions.

Cat. No. 20336X

Form 945-X (1-2009)

Name (not your trade name)

Employer Identification Number (EIN)

Calendar Year (YYYY)

Part 3: Explain your corrections for this year.

6.

Check here if any corrections you entered on a line include both underreported and overreported amounts. Explain both your
underreported and overreported amounts on line 7.

7.

You must give us a detailed explanation of how you determined your corrections. (See the instructions.)

Part 4: Sign here. You must complete both pages of this form and sign it.

Under penalties of perjury, I declare that I have filed an original Form 945 and that I have examined this adjusted return or claim and any schedules or
statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than
taxpayer) is based on all information of which preparer has any knowledge.



Sign your
name here

Date

Draft 11: 11/11/08
/

/

Print your
name here
Print your
title here

Best daytime phone

(

)

--

Paid preparer’s use only

Check if you are self employed ....................................

Preparer’s name

Preparer’s SSN/PTIN

Preparer’s signature

Date

Firm’s name (or yours
if self-employed

EIN

Address

Phone

City
Page 2

State

/

(

/

)

--

ZIP code
Form 945-X (1-2009)