(0U(s1p8vsb4T&a48c7r48LName (as distinguished from trade name)
&a+1RTrade name, if any
&a+1RAddress and ZIP code
&a147c7r147LCalendar year
&a+1REmployer identification no.
&a9c15r9LIf you do not have to file returns in the future, check here &a2234H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(0B(s0p10h12v0s1b0Tj(0U(s1p8vsb4T
&a15c16r15LNumber of agricultural employees employed in the pay period that includes March 12, 1995&a3597H . . . . . . . . . . . .(0B(s0p10h12v0s1b0Tj(0U(s1p8vsb4T
Total wages subject to social security taxes (see instructions)&a2520H . . . . . . . . . . . . .
(s1BTotal deposits(sB for 1995, including any overpayment from 1994, as shown in your records&a3530H . . . . . . . . . . . . . .
(s1BBalance due(sB (subtract line 12 from line 11 - see instructions). Pay to Internal Revenue Service &a3736H . . . . . . . . . .(0B(s0p10h12v0s1b0Tj(0U(s1p8vsb4T
(s1BOverpayment,(sB if line 12 is more than line 11, enter here (0B(s0p10h12v0s1b0Tj(0U(s1p8vsb4T
&a33R(s1B Summary of Federal Tax Liability(sB
&a141c29Rand check if to be:
&a177c29RApplied to next return, or
&a219c29RRefunded.
&a9c30r9L(0B(s0p10h12v0s1b0T|(0U(s1p8vsb4T
(0B(s0p10h12v0s1b0T|(0U(s1p8vsb4T
(0B(s0p10h12v0s1b0T|(0U(s1p8vsb4T
&a12c30r12L (s1BAll filers:(sB if line 13 is less than $500, you need not complete line 15 or Form 943-A.
(0U(s1p8vsb4T&l6.86C&a26c47.83r26LUnder 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.
(0U(s1p8vsb4T&a9c53r9L(s1BDo not send cash and do not staple your payment to this voucher.(sB Make your check or money order, with your employer identification number
clearly written on it, payable to the (s1BInternal Revenue Service.(sB
&a171c55RYour employer identification number
&l6C&a15c73.6r15LEnter the amount of the payment you
are making
&l8C&a81c55r81LEnter the first four letters of your business name
&a9c60.5RDo not staple your payment to this voucher.
&a81c58REnter your business name(s) and address
(0U(s1p6vsb4T&a15c63.8REDA
(0U(s1p8vsb4T(0U(s1p6vsb4T&a27.5c63.8RCopyright (c) 1995 form software only CPSystems, Inc.