Form Pw-1 2015 Wisconsin Nonresident Income Or Franchise Tax Withholding On Pass-Through Entity Income Page 2

2

2

2015 Form PW-1

Page

of

Part 2: Nonresident Shareholder, Partner, Member, or Beneficiary Information

(Note: See instructions corresponding to each column letter)

If affidavit (Form PW-2) was filed by nonresident, columns E through H are not required.



G.

A.

B.

C.

D.

E.

F.

H.

L

i

Share of

n

Wisconsin

Withholding

e

Tax

Affidavit

Taxable

Gross

Share of

Tax

Tax Credits

Nonresident’s Name and Address

FEIN or SSN

Form

Filed

Income

Withholding

Computed

Name

FEIN

Yes

$

$

a

$

$

Address

SSN

No

Name

FEIN

Yes

b

$

$

$

$

Address

SSN

No

Name

FEIN

Yes

$

$

$

$

c

SSN

Address

No

Name

FEIN

Yes

d

$

$

$

$

SSN

Address

No

Name

FEIN

Yes

$

e

$

$

$

Address

SSN

No

Name

FEIN

Yes

$

$

f

$

$

Address

SSN

No

Name

FEIN

Yes

$

$

$

$

g

Address

SSN

No

Name

FEIN

Yes

$

$

$

$

h

Address

SSN

No

Name

FEIN

Yes

$

$

$

$

i

SSN

Address

No

Total Wisconsin income (add lines a through i) . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

15 Total withholding this page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

16 Number of additional pages included

. Total of line 15 amount from all additional pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

17 Total withholding tax computed. Add lines 15 and 16. Enter total on Part 1, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

IC-004