Form 8109 B – Fill Out and Use This PDF

Name

Address

IRS USE

ONLY

What’s new. For Forms CT-1, 940, 943, 944, 945, and 1042, darken only the 4th quarter space for the proper tax period.

Do not use a federal tax deposit coupon (Form 8109 or Form 8109-B) to make a payment with Forms CT-1X, 941-X, 943-X, 944-X, 945-X, or with Formulario 941-X(PR).

Note. Pen or #2 pencil can be used to complete the form. The name, address, and telephone number may be completed other than by hand. You cannot use photocopies of the coupons to make your deposits. Do not staple, tape, or fold the coupons.

The IRS encourages you to make federal tax deposits using the Electronic Federal Tax Payment System (EFTPS). For more information on EFTPS, go to www.eftps.gov or call 1-800-555-4477.

Purpose of form. Use Form 8109-B to make a tax deposit only in the following two situations.

1.You have not yet received your resupply of preprinted deposit coupons (Form 8109).

2.You are a new entity and have already been assigned an employer identification number (EIN), but you have not received your initial supply of preprinted deposit coupons (Form 8109). If you have not received your EIN, see Exceptions below.

Note. If you do not receive your resupply of deposit coupons and a deposit is due or you do not receive your initial supply within 5–6 weeks of receipt of your EIN, call 1-800-829-4933.

Caution. Do not use these coupons to deposit delinquent taxes assessed by the IRS. Pay delinquent taxes directly to the IRS using the stub included with the notice or by using EFTPS.

How to complete the form. Enter your name as shown on your return or other IRS correspondence, address, and EIN in the spaces provided. Do not make a name or address change on this form (see Form 8822, Change of Address). If you are required to file a Form 1120, 1120-C,

990-PF (with net investment income), 990-T, or 2438, enter the month in which your tax year ends in the MONTH TAX YEAR ENDS boxes. For example, if your tax year ends in January, enter 01; if it ends in December, enter 12. Make your entries for EIN and MONTH TAX YEAR ENDS (if applicable) as shown in Amount of deposit below.

Exceptions. If you have applied for an EIN, have not received it, and a deposit must be made, do not use Form 8109-B. Instead, send your payment to the IRS address where you file your return. Make your check or money order payable to the United States Treasury and show on it your name (as shown on Form SS-4, Application for Employer Identification Number), address, kind of tax, period covered, and date you applied for an EIN.

Amount of deposit. Enter the amount of the deposit in the space provided. Enter the amount legibly, forming the characters as shown below:

Hand print money amounts without using dollar signs, commas, a decimal point, or leading zeros. If the deposit is for whole dollars only, enter “00” in the CENTS boxes. For example, a deposit of $7,635.22 would be entered like this:

, 7 ,6 3 5.2 2

Caution. Darken only one space for TYPE OF TAX and only one space for TAX PERIOD. Darken the space to the left of the applicable form and tax period. Darkening the wrong space or multiple spaces may delay proper crediting to your account. See below for an explanation of Types of Tax and Marking the Proper Tax Period.

Types of Tax

Form 941 Employer’s QUARTERLY Federal Tax Return (includes Forms 941-M, 941-PR, and 941-SS)

Form 943 Employer’s Annual Federal Tax Return for Agricultural Employees

Form 944 Employer’s ANNUAL Federal Tax Return (includes Forms 944-PR, 944(SP), and 944-SS)

Form 945 Annual Return of Withheld Federal Income Tax

Form 720 Quarterly Federal Excise Tax Return

Form CT-1 Employer’s Annual Railroad Retirement Tax Return

Form 940 Employer’s Annual Federal Unemployment (FUTA) Tax Return (includes Form 940-PR)

Form 1120 U.S. Corporation Income Tax Return (includes Form 1120 series of returns and Form 2438)

Form 990-T Exempt Organization Business Income Tax Return

Form 990-PF Return of Private Foundation or Section 4947(a)(1) Nonexempt

Charitable Trust Treated as a Private Foundation

Form 1042 Annual Withholding Tax Return for U.S. Source Income of Foreign Persons

Marking the Proper Tax Period

Payroll taxes and withholding. For Form 941, if your liability was incurred during:

●January 1 through March 31, darken the 1st quarter space;

●April 1 through June 30, darken the 2nd quarter space;

●July 1 through September 30, darken the 3rd quarter space; and

●October 1 through December 31, darken the 4th quarter space.

For Forms CT-1, 940, 943, 944, 945, and 1042, darken only the 4th quarter space.

Do not use a federal tax deposit coupon (Form 8109 or Form 8109-B) to make a payment with Forms CT-1X, 941-X, 943-X, 944-X, 945-X, or with Formulario 941-X(PR).

Note. If the liability for Form 941 was incurred during one quarter and deposited in another quarter, darken the space for the quarter in which the tax liability was incurred. For example, if the liability was incurred in March and deposited in April, darken the 1st quarter space.

Excise taxes. For Form 720, follow the instructions above for Form 941. For Form 990-PF, with net investment income, follow the instructions on page 2 for Form 1120, 990-T, and 2438.

Income Taxes (Forms 1120, 990-T, and 2438). To make estimated income tax deposits before the end of your tax year, darken only the 1st quarter space.

To make deposits after the end of your tax year, darken only the 4th quarter space. This includes:

●Deposits of estimated tax payments made after the end of your tax year.

●Deposits of balance due shown on the return (Forms 1120, 990-T, and 990-PF).

●Deposits of balance due shown on Form 7004, Application for Automatic Extension of Time To File Certain Business Income Tax, Information, and Other Returns (be sure to darken the 1120 or 1042 space as appropriate).

●Deposits of balance due (Forms 990-T and 990-PF filers) shown on Form 8868, Application for Extension of Time To File an Exempt Organization Return (be sure to darken the 990-T or 990-PF space as appropriate).

●Deposits of tax due shown on Form 2438, Undistributed Capital Gains Tax Return (darken the 1120 space).

How to ensure your deposit is credited to the correct account.

●Make sure your name and EIN are correct.

●Prepare only one coupon for each type of tax deposit.

●Darken only one space for the type of tax you are depositing.

●Darken only one space for the tax period for which you are making a deposit.

●Use separate FTD coupons for each return period.

Telephone number. We need your daytime telephone number to call if we have difficulty processing your deposit.

Miscellaneous. We use the “IRS USE ONLY” box to ensure proper crediting to your account. Do not darken this space when making a deposit.

How to make deposits. Mail or deliver the completed coupon with the amount of the deposit to an authorized depositary (financial institution) for federal taxes. Make your check or money order payable to that depositary. To help ensure proper crediting to your account, write your EIN, the type of tax (for example, Form 940), and the tax period to which the payment applies on your check or money order.

Authorized depositaries must accept cash, postal money orders drawn to the order of the depositary, or checks or drafts drawn on and to the order of the depositary. You can deposit taxes with a check drawn on another financial institution only if the depositary is willing to accept that form of payment.

If you prefer, you may mail your coupon and payment to Financial Agent, Federal Tax Deposit Processing, P.O. Box 970030, St. Louis, MO 63197. Make your check or money order payable to “Financial Agent.”

The Financial Agent cannot process foreign checks. If you send a check written on a foreign bank to pay a federal tax deposit, you generally will be charged a deposit penalty and will receive a bill in the mail. For more information, see How to deposit with a FTD coupon in Pub. 15 (Circular E), Employer’s Tax Guide.

Timeliness of deposits. The IRS determines whether deposits are on time by the date they are received by an authorized depositary. However, a deposit received by the authorized depositary after the due date will be considered timely if the taxpayer establishes that it was mailed in the United States in a properly addressed, postage prepaid envelope at least 2 days before the due date.

Note. If you are required to deposit any taxes more than once a month, any deposit of $20,000 or more must be received by its due date to be timely.

When to deposit. See the instructions for the applicable return. See Pub. 15 (Circular E) for deposit rules on employment taxes. Generally, you can get copies of forms and instructions by calling 1-800-TAX-FORM (1-800-829-3676) or by visiting IRS’s website at www.irs.gov.

Penalties. You may be charged a penalty for not making deposits when due or in sufficient amounts, unless you have reasonable cause. This penalty may also apply if you mail or deliver federal tax deposits to unauthorized institutions or IRS offices, rather than to authorized depositaries. Additionally, a trust fund recovery penalty may be imposed on all persons who are determined by the IRS to be responsible for collecting, accounting for, and paying over employment and excise taxes, and who acted willfully in not doing so. For more information on penalties, see Pub. 15 (Circular E). See the Instructions for Form 720 for when these penalties apply to excise taxes.

Privacy Act and Paperwork Reduction Act Notice. Internal Revenue Code section 6302 requires certain persons to make periodic deposits of taxes. If you do not deposit electronically, you must provide the information requested on this form. IRC section 6109 requires you to provide your EIN. The information on this form is used to ensure that you are complying with the Internal Revenue laws and to ensure proper crediting of your deposit. Routine uses of this information include providing it to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia for use in administering their tax laws. We may also disclose this information to federal and state agencies to enforce federal nontax criminal laws and to combat terrorism. We may give this information to other countries pursuant to tax treaties. Providing incomplete, incorrect, or fraudulent information may subject you to interest and penalties.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by IRC section 6103.

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is 3 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, IR-6526, 1111 Constitution Ave. NW, Washington, DC 20224. Do not send this form to this address. Instead, see the instructions under How to make deposits on this page.