Form 943 Employer's Annual Tax Return for Agricultural Employees

Form

943

©

Department of the Treasury
Internal Revenue Service

Enter state code
for state in which
deposits were
made only if
different from
state in address
to the right ©
(see the separate
instructions).
If you do not have
to file returns in the
future, check
©
here

1

OMB No. 1545-0035

Employer’s Annual Federal Tax Return for Agricultural Employees

Name (as distinguished from trade name)

©

2010

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

Calendar year

Trade name, if any

Employer identification number (EIN)

Address (number and street)

City, state, and ZIP code

Number of agricultural employees employed in the pay period that includes March 12, 2010

If address is
different from
prior return,
check here. ©

©

1

*Report wages, including those paid to qualified new employees, on lines 2 and 4. The social security tax exemption on wages
will be figured on line 7c and will reduce the tax on line 7d (see instructions).

2
3
4
5
6
7a
7b
7c
7d
8
9
10
11
12
13a
13b
13c
13d
13e
14
15

2
Total wages subject to social security tax* (see separate instructions)
Social security tax (multiply line 2 by 12.4% (.124))
4
Total wages subject to Medicare tax* (see separate instructions)
Medicare tax (multiply line 4 by 2.9% (.029))
Federal income tax withheld (see separate instructions)
7a
Number of qualified employees paid wages after March 31, 2010
7b
Exempt wages paid to qualified employees after March 31, 2010
Social security tax exemption (multiply line 7b by 6.2% (.062))
Total taxes before adjustments (lines 3 + line 5 + line 6 – line 7c)
Current year’s adjustments (see separate instructions)
Total taxes after adjustments (line 7d as adjusted by line 8)
Advance earned income credit (EIC) payments made to employees, if any (see separate instructions)
Net taxes (subtract line 10 from line 9)
Total deposits for 2010, including overpayment applied from a prior year and Form 943-X
COBRA premium assistance payments (see instructions)
13b
Number of individuals provided COBRA premium assistance
13c
Number of qualified employees paid exempt wages March 19-31
13d
Exempt wages paid to qualified employees March 19-31

3
5
6
See instructions for definitions
of qualified employee and
exempt wages.

7c
7d
8
9
10
11
12
13a

13e
Social security tax exemption (multiply line 13d by 6.2% (.062)
14
Add lines 12, 13a, and 13e
Balance due. If line 11 is more than 14, write the difference here. For information on how to pay,
©
see the instructions
15
©
16 Overpayment. If line 14 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 17 or Form 943-A.
● Semiweekly schedule depositors: Complete Form 943-A and check here ©
● Monthly schedule depositors: Complete line 17 and check here ©
17 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)
Tax liability for month

Tax liability for month

Tax liability for month

A January

F June

K November

B February

G July

L December

C March
D April
E May

H August
I September
J October

M Total liability for year
(add lines A
through L)

ThirdParty
Designee

Sign
Here

Do you want to allow another person to discuss this return with the IRS (see separate instructions)?
Designee’s
name ©

No.

Personal identification
number (PIN) ©

)

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Signature

Paid
Preparer
Use Only

Phone
no. © (

Yes. Complete the following.

©

Print/Type preparer’s name

Firm’s name

Print Your
Name and Title
Preparer’s signature

©

Firm’s address

©

Date

Check
if
self-employed
Firm’s EIN

©

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

Date
PTIN

©

©

Phone no.
Cat. No. 11252K

Form

943

(2010)

Form 943-V,
Payment Voucher

Making Payment With Form 943
To avoid a penalty, make your payment with your 2010
Form 943 only if:
● Your net taxes for the year (line 11 on Form 943) are
less than $2,500 and you are paying 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. In this case, the
amount of your payment may be $2,500 or more.
Otherwise, you must deposit your payment by using
the Electronic Federal Tax Payment System (EFTPS).
See section 7 of Pub. 51 (Circular A) for deposit
instructions. Do not use Form 943-V to make federal
tax deposits.

✁

Ä

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.
Box 2—Amount paid. Enter the amount paid with
Form 943.
Box 3—Name and address. Enter your name and
address as shown on Form 943.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure to enter your
EIN, “Form 943,” and “2010” on your check or money
order. Do not send cash. Do not attach Form 943-V or
your payment to Form 943 (or to each other).
● Detach Form 943-V and send it with your payment
and Form 943 to the address provided in the
Instructions for Form 943.
Note. You must also complete the entity information
above line 1 on Form 943.

Detach Here and Mail With Your Payment and Form 943. Ä
Payment Voucher

Form 943-V
Department of the Treasury
Internal Revenue Service

1

Caution. Use Form 943-V when making any payment
with Form 943. However, 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).

Enter your employer identification number (EIN).

©

OMB No. 1545-0035

2010

Do not attach this voucher or your payment to Form 943.
2

Dollars

Enter the amount of your payment
3

©

Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city, state, and ZIP code.

✃

Purpose of Form
Complete Form 943-V, Payment Voucher, 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.
If you have your return prepared by a third party and
make a payment with that return, please provide
Form 943-V to the return preparer.

Cents