Form Tc-65pa - Utah Composite Return For Nonresident Professional Team Members
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65921
Utah Composite Return for
Nonresident Professional Team Members TC-65PA
For the 2009 calendar year, or fiscal year______________ to ______________.
9999
mm/dd/yyyy
mm/dd/yyyy
_ _ _ IF AMENDED RETURN - ENTER CODE (1-4) from page 2
_ _ _ Mark “X” if you filed federal Form 8886
Team name
Mark “X” if this
is a new address:
Team Employer Identification Number:
Team address
_ _ _ Physical
__ _ _ _ ______________
address
City
State
ZIP +4
_ _ _ Mailing
address
Foreign country (if not U.S.)
Telephone number
1. Utah composite return taxable income (attach TC-65PA, Sch. N)................................
1 _____________ __ _ _ . 00
2. Utah tax (multiply line 1 by 5% (.05)) .........................................................................
2 _____________ _ __ _ . 00
3. Prepayments made for tax year..................................................................................
3 _____________ _ __ _ . 00
4. Amended returns only (see instructions) ....................................................................
4 _____________ _ __ _ . 00
5. Total payments – Add line 3 and line 4. If less than zero, enter “0” ...........................
5 ______________ _ __ . 00
6. Tax Due – If line 2 is greater than line 5, subtract line 5 from line 2 ...........................
6 _____________ _ __ _ . 00
7. Penalties and interest (see instructions) .....................................................................
7 _____________ __ _ _ . 00
8. Pay this amount ........................................................................................................
8 _____________ __ _ _ . 00
Add line 6 and line 7. Make check payable to Utah State Tax Commission
9. Overpayment – If line 5 is greater than line 2, subtract line 2 from line 5..................
9 _____________ _ __ _ . 00
10. Amount of overpayment on line 9 to be applied to next year’s tax..............................
10 _____________ _ __ _ . 00
11. Refund – Subtract line 10 from line 9.........................................................................
11 _____________ __ _ _ . 00
USTC USE ONLY
_ _ _ _
Under penalties of perjury, I declare to the best of my knowledge and belief,
this return and accompanying schedules are true, correct and complete.
Signature of officer
Title
Date
Check here if the Tax Commission
SIGN
may discuss this return with the
HERE
preparer shown below (see page 5)
Preparer’s signature
Date
Preparer’s SSN or PTIN
Paid
Preparer's
Name of preparer’s firm (or yourself, if self-employed)
Preparer’s phone no.
Preparer’s EIN
Section
Preparer’s complete address (street, city, state, ZIP)
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