0510 Form 940-B (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f940b.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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The Form 940 filed with the IRS by the employer named above indicates the following information for the calendar year shown.

I certify that, except as shown above, the records of this office agree with the entries shown in columns (2), (3), (4), (5), and (6), and that all contributions were paid before February 1.

Part 1 -State Agency copy Cat. No. 20910X Form 940-B (Rev. 5-2010)

The Form 940 filed with the IRS by the employer named above indicates the following information for the calendar year shown.

I certify that, except as shown above, the records of this office agree with the entries shown in columns (2), (3), (4), (5), and (6), and that all contributions were paid before February 1.

Part 2 -Suspense/Case file copy Cat. No. 20910X Form 940-B (Rev. 6-2010)