Transaction No. 36 Form 940 for 20--: Employer's Annual Federal Unemployment (FUTA) Tax Return Department of the Treasury - Internal Revenue Service OMB No. 1545-0028 (EIN) 0 0 0 0 6 6 0 Employer identification number Type of Return (Check all that apply.) Name (not your trade name) GLO-BRITE PAINT COMPANY a. Amended Trade name (if any) b. Successor employer c. No payments to employees in Address 2215 SALVADOR ST 20-- Number Street Suite or room number d. Final: Business closed or PHILADELPHIA PA 19175 -0682 stopped paying wages State 4P code Read the separate instructions before you fill out this form. Please type or print within the boxes. Part 1: Tell us about your return. If any line does NOT apply, leave it blank. If you were required to pay your state unemployment tax in ... la One state only, write the state abbreviation . 1a - OR - 1b More than one state (You are a multi-state employer) . 1b Check here. Fill out Schedule A. 2 If you paid wages in a state that is subject to CREDIT REDUCTION 2 Check here. Fill out Schedule A Form 940), Part 2. Part 2: Determine your FUTA tax before adjustments for 20-. If any line does NOT apply, leave it blank 3 Total payments to all employees 4 Payments exempt from FUTA tax . Check all that apply: 4a |Fringe benefits 4c Retirement/Pension 4e Other 4b Group-term life insurance 4d Dependent care 5 Total of payments made to each employee in excess of $7,000 . 5 6 Subtotal (line 4 + line 5 = line 6) . 7 Total taxable FUTA wages (line 3 - line 6 = line 7) FUTA tax before adjustments (line 7 x .006 = line 8) CO Part 3: Determine your adjustments. If any line does NOT apply, leave it blank 9 If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax, multiply line 7 by .054 (line 7 x .054 = line 9). Then go to line 12 9 10 If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax, OR you paid ANY state unemployment tax late (after the due date for filing Form 940), fill out the worksheet in the instructions. Enter the amount from line 7 of the worksheet 10 11 If credit reduction applies, enter the amount from line 3 of Schedule A (Form 940) . 11 Part 4: Determine your FUTA tax and balance due or overpayment for 20--. If any line does NOT apply, leave it blank