Form 945 - Annual Return Of Withheld Federal Income Tax - 2012
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2945
Annual Return of Withheld Federal Income Tax
OMB No. 1545-1430
Form
For withholding reported on Forms 1099 and W-2G.
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2012
See separate instructions. For more information on income tax withholding, see Pub. 15 (Circ. E) and Pub. 15-A.
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Department of the Treasury
Internal Revenue Service
Information about Form 945 and its separate instructions is at
Name (as distinguished from trade name)
Calendar year
If address is
Type
different
Trade name, if any
Employer identification number (EIN)
or
from prior
Print
return, check
here.
Address (number and street)
City, state, and ZIP code
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A
If you do not have to file returns in the future, check here
and enter date final payments made.
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1
1
Federal income tax withheld from pensions, annuities, IRAs, gambling winnings, etc. .
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2
Backup withholding
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2
3
Total taxes. If $2,500 or more, this must equal line 7M below or line M of Form 945-A
3
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4
Total deposits for 2012, including overpayment applied from a prior year and overpayment applied
from Form 945-X
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4
5
Balance due. If line 3 is more than line 4, enter the difference and see the separate instructions .
5
6
Overpayment. If line 4 is more than line 3, enter the difference
$
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Check one:
Apply to next return.
Send a refund.
• All filers: If line 3 is less than $2,500, do not complete line 7 or Form 945-A.
• Semiweekly schedule depositors: Complete Form 945-A and check here .
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• Monthly schedule depositors: Complete line 7, entries A through M, and check here
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7 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)
Tax liability for month
Tax liability for month
Tax liability for month
A January .
F June .
K November
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B February
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G July .
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L December
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C March
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H August
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M Total
liability
for
D April .
I September .
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year (add lines A
through L )
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E May .
J October .
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Do you want to allow another person to discuss this return with the IRS (see the instructions)?
Yes. Complete the following.
No.
Third-
Party
Designee
Designee’s
Phone
Personal identification
name
no.
number (PIN)
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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
Sign
belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here
Print Your
Signature
Name and Title
▶
Date
▶
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Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
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Firm’s address
Phone no.
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945
Form
(2012)
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 14584B
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