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26 U.S.C. § 7203
Sole Proprietorship or Partnership
Employer's Quarterly Return - Failure to File
Venue in District of Service Center 1IN THE DISTRICT COURT OF THE UNITED STATES FOR THE ____________ DISTRICT OF ____________
UNITED STATES OF AMERICA
v.
_______________________
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)
)
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)No. __________________
26 U.S.C., § 7203The United States Attorney charges:
That during the period from [Date] to [Date], inclusive, [Defendant's Name], a resident of [City], [State], was an employer of labor1 and a person required under the provisions of the Internal Revenue Code to make a return of federal income taxes withheld from wages and Federal Insurance Contributions Act (F.I.C.A.) taxes; that during said period he [she] paid wages to his [her] employees which were subject to withholding of federal income taxes and Federal Insurance Contributions Act taxes in the sum of $____________ and $______________, respectively; that by reason of such facts he [she] was required by law, after [Last Day of Period], and on or before [Return Due Date], to make an Employer's Quarterly Federal Tax Return, Form 941, to the Director, Internal Revenue Service Center, at [City], [State], in the _______________ District of _____________, or to the District Director of the Internal Revenue Service for the Internal Revenue District of _____________, at _____________,2 or other proper officer of the United States; and that well-knowing and believing all of the foregoing, he [she] did willfully fail to make said return to said Director of the Internal Revenue Service Center, to said District Director of the Internal Revenue Service, or to any other proper officer of the United States.
In violation of Title 26, United States Code, Section 7203.
_________________________
United States Attorney
NOTES1. If employer is a corporation, refer to Forms - 25 as a guide in charging appropriate corporate officials with failure to file return on behalf of corporation.
2. If venue is to be placed in the judicial district of the District Director, modify this form in accordance with language at Forms - 33.
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Uploaded April 1998
