Here is an example of a 941 form. https://www.irs.gov/pub/irs-pdf/f941.pdf
Fill out the 941 IRS form using the information below:
Gem City Accounting (EIN: 01-2345678) is classified as a monthly depositor and pays its employees monthly. They have 11 employees and their address is 444 West Third Street, Dayton, OH 45412. The following payroll information is for the fourth quarter of 2019:
Deposits
October: $1,845.56
November $1,730.48
December: $802.68
Total Deposits: $4,378.72
| EMPLOYEE WITHHOLDINGS | EMPLOYER'S WITHHOLDING |
| | Wages | OASDI | HI | FIT | OASDI | HI |
| October | $5,571.68 | $ 345.42 | $80.76 | $ 993.00 | $ 345.42 | $80.76 |
| November | 5,133.48 | 318.30 | 74.44 | 945.00 | 318.30 | 74.44 |
| December | 3,509.04 | 217.55 | 50.89 | 266.00 | 217.55 | 50.89 |
| Totals | $14,214.20 | $881.27 | $206.09 | $2,204.00 | $881.27 | $206.09 |
Form Bavar 2018 941 for 2018: Employer's QUARTERLY Federal Tax Return 950117 OMB No 1545-0029 Decadimento the Trees - Internal Revenue Senica 6 8 9 Employer identification number (EIN) 1 2 Name (not your trade name) Paul's Plumbing, LLC Trade name any Paul's Plumbing, LLC Address 1234 Plummer Lane Report for this Quarter of 2018 (Check one.) 1: January, February, March 2: April, May, June 3: July, August, September 4: October, November, December Go to www.irs.gov/Form941 for instructions and the latest information. Number Street Sulte or room number Los Angeles CA 90038 ZIP code City State Foreign country name 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 1 1 11 2 23049 00 N 3 3 1111 00 4 Check and go to line 6. 84 x 0.124 = 700 64 x 0.009 = 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 Column 2 5a Taxable social security wages. 24160. 000.124 = 2995 5b Taxable social security tips. 5c Taxable Medicare wages & tips. 24160 00 x 0.029 5d Taxable wages & tips subject to Additional Medicare Tax withholding 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 Current quarter's adjustment for sick pay Current quarter's adjustments for tips and group-term life insurance 5e 5e 3696 48 5f 6 6 4807 48 7 7 8 8 9 9 10 10 Total taxes after adjustments. Combine lines 6 through 9 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11 11 12 12 4807 48 13 Total taxes after adjustments and credits. Subtract line 11 from line 10 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter Balance due. If line 12 is more than line 13, enter the difference and see instructions 13 4807 48 14 14 0 00 15 Check one: Apply to next return Overpayment. If line 13 is more than line 12, enter the difference You MUST complete both pages of Form 941 and SIGN it. Send a refund Next 950217 Name (not your trade name) Employer identification number (EIN) Paul's Plunning, LLC 12-3456789 Part 2: Tel us about your deposit schedule and tax liability for this quarter. vou are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. 16 Check one: Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 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). Go to Part 3 X You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 1683 Tax liability: Month 1 00 Month 2 1558. 48 Month 3 1566. 00 Total liability for quarter 4807. 48 Total must equal line 12. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages Check here, and enter the final date you paid wages 18 If you are a seasonal employer and you don't have to file a return for quarter of the year Check here. Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee's name and phone number Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS. No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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) based on all information of which preparer has any knowledge. Print your Sign your name here name here Print your title here X Date / / Best daytime phone Paid Preparer Use Only Check if you are self-employed Preparer's name PTIN Date Preparer's signature Firm's name (or yours if self-employed) EIN Address Phone City State ZIP code 01 . and Tonet nists MO ... ware ITmemo Me. Tatty! Form Bavar 2018 941 for 2018: Employer's QUARTERLY Federal Tax Return 950117 OMB No 1545-0029 Decadimento the Trees - Internal Revenue Senica 6 8 9 Employer identification number (EIN) 1 2 Name (not your trade name) Paul's Plumbing, LLC Trade name any Paul's Plumbing, LLC Address 1234 Plummer Lane Report for this Quarter of 2018 (Check one.) 1: January, February, March 2: April, May, June 3: July, August, September 4: October, November, December Go to www.irs.gov/Form941 for instructions and the latest information. Number Street Sulte or room number Los Angeles CA 90038 ZIP code City State Foreign country name 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 1 1 11 2 23049 00 N 3 3 1111 00 4 Check and go to line 6. 84 x 0.124 = 700 64 x 0.009 = 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 Column 2 5a Taxable social security wages. 24160. 000.124 = 2995 5b Taxable social security tips. 5c Taxable Medicare wages & tips. 24160 00 x 0.029 5d Taxable wages & tips subject to Additional Medicare Tax withholding 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 Current quarter's adjustment for sick pay Current quarter's adjustments for tips and group-term life insurance 5e 5e 3696 48 5f 6 6 4807 48 7 7 8 8 9 9 10 10 Total taxes after adjustments. Combine lines 6 through 9 Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11 11 12 12 4807 48 13 Total taxes after adjustments and credits. Subtract line 11 from line 10 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter Balance due. If line 12 is more than line 13, enter the difference and see instructions 13 4807 48 14 14 0 00 15 Check one: Apply to next return Overpayment. If line 13 is more than line 12, enter the difference You MUST complete both pages of Form 941 and SIGN it. Send a refund Next 950217 Name (not your trade name) Employer identification number (EIN) Paul's Plunning, LLC 12-3456789 Part 2: Tel us about your deposit schedule and tax liability for this quarter. vou are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15. 16 Check one: Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, and you didn't incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior quarter was less than $2,500 but line 12 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). Go to Part 3 X You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3 1683 Tax liability: Month 1 00 Month 2 1558. 48 Month 3 1566. 00 Total liability for quarter 4807. 48 Total must equal line 12. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages Check here, and enter the final date you paid wages 18 If you are a seasonal employer and you don't have to file a return for quarter of the year Check here. Part 4: May we speak with your third-party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions for details. Yes. Designee's name and phone number Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS. No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. 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) based on all information of which preparer has any knowledge. Print your Sign your name here name here Print your title here X Date / / Best daytime phone Paid Preparer Use Only Check if you are self-employed Preparer's name PTIN Date Preparer's signature Firm's name (or yours if self-employed) EIN Address Phone City State ZIP code 01 . and Tonet nists MO ... ware ITmemo Me. Tatty
