Form (Rev. January 2011)
Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund
Department of the Treasury -- Internal Revenue Service -- OMB No. 1545-0029
(EIN) Employer identification number Name (not your trade name) Trade name (if any) Address
Return You Are Correcting ...
Check the type of return you are correcting:
Check the ONE quarter you are correcting:...
Fill & Sign Online, Print, Email, Fax, or Download
Jan 8, 2016 ... For example, use Form 941-X, Adjusted Employers QUARTERLY Federal Tax
Return or Claim for Refund, to correct errors on a previously filed Form 941. ...
2011 Form 940 (PDF) · Form 843 (.pdf), Claim for Refund and ...