Part 5: |
Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6. |
16 |
Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for a quarter, leave the line blank. |
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16a |
1st quarter (January 1 – March 31) . . . . . . . . |
16a |
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16b |
2nd quarter (April 1 – June 30) . . . . . . . . . |
16b |
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16c |
3rd quarter (July 1 – September 30) . . . . . . . |
16c |
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16d |
4th quarter (October 1 – December 31) . . . . . . |
16d |
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17 |
Total tax liability for the year (lines 16a + 16b + 16c + 16d = line 17) |
17 |
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Total must equal line 12. |
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Part 6: |
May we speak with your third-party designee? |
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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.
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Yes. |
Designee’s name and phone number |
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Select a 5-digit personal identification number (PIN) to use when talking to the IRS. |
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No. |
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Part 7: |
Sign here. You MUST complete both pages of this form 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, and that no part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments made to employees. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
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Sign your name here |
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Print your name here |
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Print your title here |
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Paid Preparer Use Only |
Check if you are self-employed . . .
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Preparer's name |
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PTIN |
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Preparer's signature |
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Date |
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Firm's name (or yours if self-employed) |
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EIN |
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Address |
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Phone |
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ZIP code |
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