945-X Adjusted Annual Return of Federal Tax Liability or Claim

945-X:

Form
(January 2009)

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

Employer identification number
(EIN)

OMB No. 1545-1430

Return You Are Correcting ...

—

Enter the calendar year of the return
you are correcting:

Name (not your trade name)

(YYYY)
Trade name (if any)

Address
Number

Street

Enter the date you discovered errors:

Suite or room number

/
City

State

ZIP code

/

(MM / DD / YYYY)

Use this form to correct errors made on Form 945, Annual Return of Withheld Federal Income Tax, for one 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 you 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
of 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)

Amount originally
reported or as
previously corrected
(for ALL payees)

—

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

.

—

.

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

.

—

.

5.

Column 3

=

Difference
(If this amount is a
negative number,
use a minus sign.)

=

=

.

.

.

Total. Combine the amounts in 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. For information on how to pay,
see Amount You Owe in the instructions for line 5.

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.

Print your
name here

Sign your
name here

Date

Print your
title here
/

Best daytime phone (

/

Paid preparer’s use only

Preparer’s
SSN/PTIN

Preparer’s signature

Date

Firm’s name (or yours if
self-employed)

EIN

Address

Phone

Page

2

–

Check if you are self-employed

Preparer’s name

City

)

State

/

(

/

)

–

ZIP code
Form

945-X

(1-2009)