Annual Withholding Tax Return For Us Source Income Of Foreign Persons Form 1042 (2013)

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1042
Annual Withholding Tax Return for
OMB No. 1545-0096
U.S. Source Income of Foreign Persons
2013
Form
Department of the Treasury
Information about Form 1042 and its separate instructions is at
Internal Revenue Service
If this is an amended return, check here .
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Name of withholding agent
Employer identification number
For IRS Use Only
CC
FD
Number, street, and room or suite no. (if a P.O. box, see instructions)
RD
FF
CAF
FP
City or town, province or state, and ZIP or foreign postal code
CR
I
EDC
SIC
If you will not be liable for returns in the future, check here
Enter date final income paid
Check if you are a:
QI/Withholding foreign partnership or trust
NQI/Flow-through entity
(See instructions.)
Record of Federal Tax Liability (Do not show federal tax deposits here.)
Tax liability for period
Tax liability for period
Tax liability for period
Line
Period
(including any taxes assumed
Line
Period
(including any taxes assumed
Line
Period
(including any taxes assumed
ending
on Form(s) 1000)
ending
on Form(s) 1000)
ending
on Form(s) 1000)
No.
No.
No.
1
21
41
7
7
7
2
15
22
15
42
15
Jan.
May
Sept.
3
22
23
22
43
22
4
24
44
31
31
30
5 Jan. total
25 May total
45 Sept. total
6
7
26
7
46
7
7
27
47
15
15
15
Feb.
June
Oct.
8
22
28
22
48
22
9
28
29
30
49
31
10 Feb. total
30 June total
50 Oct. total
11
31
51
7
7
7
12
15
32
15
52
15
Mar.
July
Nov.
13
22
33
22
53
22
14
34
54
31
31
30
15 Mar. total
35 July total
55 Nov. total
16
7
36
7
56
7
17
37
57
15
15
15
Apr.
Aug.
Dec.
18
22
38
22
58
22
19
30
39
31
59
31
20 Apr. total
40 Aug. total
60 Dec. total
61
No. of Forms 1042-S filed: a On paper
b Electronically
62
For all Form(s) 1042-S and 1000: a Gross income paid
b Taxes withheld or assumed
63a Total tax liability (add monthly total lines from above)
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63a
b Adjustments (see instructions) .
63b
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c Total net tax liability (combine lines 63a and 63b)
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63c
Total paid by electronic funds transfer (or with a request for an
64
extension of time to file) for 2013
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64
65
Enter overpayment applied as a credit from 2012 Form 1042 .
65
66
Credit for amounts withheld by other withholding agents (see instructions)
66
67
Total payments. Add lines 64 through 66 .
67
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68
If line 63c is larger than line 67, enter balance due here
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68
69
If line 67 is larger than line 63c, enter overpayment here .
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69
70
Apply overpayment on line 69 to (check one):
Credit on 2014 Form 1042 or
Refund
71
Excise tax on specified federal procurement payments included on line 63a.
(Total payments made
x 2% =
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71
)
Third Party
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following.
No
Designee’s
Phone
Personal identification
Designee
name
no.
number (PIN)
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
Sign
belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer has any knowledge.
Date
Capacity in which acting
Here
Your
signature
Daytime phone number
Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
Firm’s address
Phone no.
1042
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(2013)
Cat. No. 11384V

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