Form 943 Employer's Annual Tax Return for Agricultural Employees

Form

943

Department of the Treasury
Internal Revenue Service

▶

Type
or
Print

Employer identification number (EIN)

Trade name, if any

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

Address (number and street)
City or town, state or province, country, and ZIP or foreign postal code

If you don't have to file returns in the future, check here

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Number of agricultural employees employed in the pay period that includes March 12, 2016
Total wages subject to social security tax . . . . . . . . . .
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Social security tax (multiply line 2 by 12.4% (0.124)) . . . . . . . . . . . . .
Total wages subject to Medicare tax . . . . . . . . . . . .
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Medicare tax (multiply line 4 by 2.9% (0.029)) . . . . . . . . . . . . . . .
Total wages subject to Additional Medicare Tax withholding . . . .
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Additional Medicare Tax withholding (multiply line 6 by 0.9% (0.009)) . . . . . . .
Federal income tax withheld
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Total taxes before adjustments. Add lines 3, 5, 7, and 8 . . . . . . . . . . .
Current year’s adjustments . . . . . . . . . . . . . . . . . . . . .
Total taxes after adjustments (line 9 as adjusted by line 10) . . . . . . . . . .
Total deposits for 2016, including overpayment applied from a prior year and Form 943-X

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2016

Information about Form 943 and its separate instructions is at www.irs.gov/form943.

Name (as distinguished from trade name)

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OMB No. 1545-0035

Employer’s Annual Federal Tax Return for Agricultural Employees

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13a

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Balance due. If line 11 is more than line 12, enter the difference and see the instructions .
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Overpayment. If line 12 is more than line 11, enter the difference ▶ $
Check one: Apply to next return.

Send a refund.

• All filers: If line 11 is less than $2,500, don't 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. (Don't complete if you were a semiweekly schedule depositor.)
Tax liability for month

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B
C
D
E

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February .
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May . .

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Tax liability for month

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June . .
July . .
August .
September
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Tax liability for month

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L

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November .
December .

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

ThirdParty
Designee

Do you want to allow another person to discuss this return with the IRS? See separate instructions.

Sign
Here

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.

Paid
Preparer
Use Only

Designee’s
name ▶

Print Your
Name and Title ▶
Preparer’s signature

Firm’s name ▶
Firm’s address

Date

Check
if
self-employed
Firm’s EIN

▶

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

No.

Personal identification
number (PIN) ▶

Phone
no. ▶

Signature ▶
Print/Type preparer’s name

Yes. Complete the following.

Date ▶
PTIN

▶

Phone no.
Cat. No. 11252K

Form

943 (2016)

Form 943-V,
Payment Voucher
Purpose of Form

Specific Instructions

Complete Form 943-V if you're making a payment with
Form 943. We will use the completed voucher to credit
your payment more promptly and accurately, and to
improve our service to you.

Box 1—Employer identification number (EIN). If you
don't have an EIN, you may apply for one online. Go to
IRS.gov and type “EIN” in the search box. You may also
apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven't received your EIN by the due date of
Form 943, 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
“United States Treasury.” Be sure to enter your EIN,
“Form 943,” and “2016” on your check or money order.
Don't send cash. Don't 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.

To avoid a penalty, make your payment with your 2016
Form 943 only if:
• Your total taxes after adjustments for the year (Form
943, line 11) are less than $2,500 and you're paying in full
with a timely filed return, or
• You're a monthly schedule depositor making a payment
in accordance with the Accuracy of Deposits Rule. See
section 7 of Pub. 51 for details. In this case, the amount
of your payment may be $2,500 or more.
Otherwise, you must make deposits by electronic funds
transfer. See section 7 of Pub. 51 for deposit instructions.
Don't use Form 943-V to make federal tax deposits.
Use Form 943-V when making any payment with
! Form 943. However, if you pay an amount with
CAUTION
Form 943 that should've been deposited, you may
be subject to a penalty. See Deposit Penalties in section 7
of Pub. 51.

▲

✁
Form

▼ Detach Here and Mail With Your Payment and Form 943. ▼

943-V

Department of the Treasury
Internal Revenue Service

1 Enter your employer identification number (EIN).

Payment Voucher
▶

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OMB No. 1545-0035

2016

Don't attach this voucher or your payment to Form 943.

Enter the amount of your payment . . .

▶

Make your check or money order payable to “United States Treasury”
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✃

Making Payment With Form 943

Enter your business name (individual name if sole proprietor).
Enter your address.
Enter your city or town, state or province, country, and ZIP or foreign postal code.

Dollars

Cents