Form 941-V Payment Voucher

5

OTC

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 941, PAGE 3 of 4
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: 31⁄ 4 " FROM BOTTOM
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 941-V,
Payment Voucher

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Purpose of Form

Specific Instructions

Complete Form 941-V, Payment Voucher, if you are
making a payment with Form 941, Employer’s
QUARTERLY Federal Tax Return. We will use the
completed voucher to credit your payment more
promptly and accurately, and to improve our service to
you.
If you have your return prepared by a third party and
make a payment with that return, please provide this
payment voucher to the return preparer.

Making Payments With Form 941

To avoid a penalty, make your payment with Form 941
only if:

● Your net taxes for the quarter (line 10 on Form 941)
are less than $2,500 and you are paying in full with a
timely filed return or
● You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 (Circular E),
Employer’s Tax Guide, for details. In this case, the
amount of your payment may be $2,500 or more.
Otherwise, you must deposit your taxes at an
authorized financial institution or by electronic funds
transfer. See section 11 of Pub. 15 (Circular E) for
deposit instructions. Do not use Form 941-V to make
federal tax deposits.
Caution. Use Form 941-V when making any payment
with Form 941. However, if you pay amounts with Form
941 that should have been deposited, you may be
subject to a penalty. See Deposit Penalties in section
11 of Pub. 15 (Circular E).

Form

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Box 1—Employer identification number (EIN). If you
do not have an EIN, apply for one on Form SS-4,
Application for Employer Identification Number, and
write “Applied For” and the date you applied in this
entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941.
Box 3—Tax period. Darken the capsule identifying the
quarter for which the payment is made. Darken only
one capsule.
Box 4—Name and address. Enter your name and
address as shown on Form 941.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure also to enter
your EIN, “Form 941,” and the tax period on your
check or money order. Do not send cash. Please do
not staple Form 941-V or your payment to the return
(or to each other).
● Detach Form 941-V and send it with your payment
and Form 941 to the address provided in the
Instructions for Form 941.
Note. You must also complete the entity information
above Part 1 on Form 941.

Detach Here and Mail With Your Payment and Form 941.

941-V

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0029

Payment Voucher
©

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2007

Do not staple or attach this voucher to your payment.

1 Enter your employer identification
number (EIN).

2

Dollars

3 Tax period

4 Enter your business name (individual name if sole proprietor).

Enter the amount of your payment.

1st
Quarter

3rd
Quarter

Enter your address.

2nd
Quarter

4th
Quarter

Enter your city, state, and ZIP code.

©

Cents

5

MAILOUT

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 941, PAGE 3 of 4
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK AND RED
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: 73⁄ 4 " FROM TOP (31⁄ 4 " FROM BOTTOM)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Separation 1: Black

Purpose of Form

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Complete Form 941-V, Payment Voucher, if you are
making a payment with Form 941, Employer’s
QUARTERLY Federal Tax Return. We will use the
completed voucher to credit your payment more
promptly and accurately, and to improve our service to
you.

If you have your return prepared by a third party and
make a payment with that return, please provide this
payment voucher to the return preparer.

Making Payments With Form 941

To avoid a penalty, make your payment with Form 941
only if:
● Your net taxes for the quarter (line 10 on Form 941)
are less than $2,500 and you are paying in full with a
timely filed return or
● You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 (Circular E),
Employer’s Tax Guide, for details. In this case, the
amount of your payment may be $2,500 or more.
Otherwise, you must deposit your taxes at an
authorized financial institution or by electronic funds
transfer. See section 11 of Pub. 15 (Circular E) for
deposit instructions. Do not use Form 941-V to make
federal tax deposits.

✁

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Caution. Use Form 941-V when making any payment
with Form 941. However, if you pay amounts with Form
941 that should have been deposited, you may be
subject to a penalty. See Deposit Penalties in section
11 of Pub. 15 (Circular E).

Specific Instructions

● Enter on the voucher the amount paid with
Form 941.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure also to enter
your EIN, “Form 941,” and the tax period on your
check or money order. Do not send cash. Please do
not staple Form 941-V or your payment to the return
(or to each other).
● Detach Form 941-V and send it with your payment
and Form 941 to the address in the Instructions for
Form 941. Do not send a photocopy of Form 941-V
because your payment may be misapplied or delayed.
If any of the preprinted information is incorrect, make
changes on the top of Form 941, not on the payment
voucher. If you change any of the preprinted
information on the voucher, your payment may be
misapplied or delayed.

Detach Here and Mail With Your Payment and Form 941.

Department of the Treasury
Internal Revenue Service

Ä

OMB No. 1545-0029

2007

©

Use this voucher when making a payment with your tax return.

©

Do not staple this voucher or your payment to your return.

©

Do not send cash.

✃

Form 941-V,
Payment Voucher

Separation 2: Red

Form 941-V, Payment Voucher
Enter the amount of
your payment

Dollars
©

Cents