You can send us comments from www.irs.gov/formspubs. Click on More Information and then click on Give us feedback. Box 1 Employer identification number EIN. If you do not have an EIN you may apply for one online. Go to IRS.gov and type EIN in the search box. 1 January February March Name not your trade name 2 April May June Trade name if any 3 July August September 4 October November December Address Number Street Suite or room number City State Foreign country name Instructions and prior year forms are available at www.irs.gov/form941. Cat. No. 17001Z Form 941 Rev. 1-2015 Part 2 Tell us about your deposit schedule and tax liability for this quarter. 941 for 2015 Form Rev. January 2015 Employer s QUARTERLY Federal Tax Return 950114 OMB No. 1545-0029 Department of the Treasury Internal Revenue Service Report for this Quarter of 2015 Employer identification number EIN Check one. ZIP code Foreign postal code Foreign province/county Read the separate instructions before you complete Form 941. Type or print within the boxes. Part 1 Answer these questions for this quarter. 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 or Dec* 12 Quarter 4 Wages tips and other compensation. Federal income tax withheld from wages tips and other compensation. If no wages tips and other compensation are subject to social security or Medicare tax Column 1 5a Taxable social security wages. 5b 5c Taxable Medicare wages tips. 5d Taxable wages tips subject to Additional Medicare Tax withholding 5e Add Column 2 from lines 5a 5b 5c and 5d 5f Section 3121 q Notice and Demand Tax due on unreported tips see instructions Total taxes before adjustments. Add lines 3 5e and 5f. Current quarter s adjustment for fractions of cents. Check and go to line 6. Total taxes after adjustments. Combine lines 6 through 9 Total deposits for this quarter including overpayment applied from a prior quarter and overpayments applied from Form 941-X 941-X PR 944-X 944-X PR or 944-X SP filed in the current quarter. Balance due. If line 10 is more than line 11 enter the difference and see instructions Overpayment. If line 11 is more than line 10 enter the difference Apply to next return* Next You MUST complete both pages of Form 941 and SIGN it. For Privacy Act and Paperwork Reduction Act Notice see the back of the Payment Voucher. Send a refund. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor see Pub. 15 Circular E section 11. Line 10 on this return is less than 2 500 or line 10 on the return for the prior quarter was less than 2 500 and you did not incur a 100 000 next-day deposit obligation during the current quarter. If line 10 for the prior quarter was less than 2 500 but line 10 on this return is 100 000 or more you must provide a record of your federal tax liability. If you are a monthly schedule depositor complete the deposit schedule below if you are a semiweekly schedule depositor attach Schedule B Form 941.
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