Form Tc-250 - Credits Received From Upper-Tier Pass-Through Entities And Mineral Production Withholding Tax Credit On Tc-675r - 2012

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Credits Received from Upper-tier Pass-through Entities
TC-250
25201
and Mineral Production Withholding Tax Credit on TC-675R
2012
(Use with TC-20S & TC-65)
Employer Identification Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Part 1
Utah Nonrefundable Credits Received from Upper-tier Pass-through Entities
Upper-tier pass-through entity Name of upper-tier pass-through entity
Credit
UT nonrefundable credit
EIN from Utah Sch. K-1 box “A” from Utah Schedule K-1 box “B”
Code
from Utah Sch. K-1
1.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
2.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
3.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
4.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
5.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
6.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
Enter these credits on TC-20S Sch. K line 18, or TC-65 Sch. K line 17, using the credit code above. Combine amounts for the same code.
Part 2
Utah Refundable Credits Received from Upper-tier Pass-through Entities
Upper-tier pass-through entity Name of upper-tier pass-through entity
Credit
UT refundable credit
EIN from Utah Sch. K-1 box “A” from Utah Schedule K-1 box “B”
Code
from Utah Sch. K-1
1.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
2.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
3.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
4.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
5.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
6.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
7.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
8.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
9.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
10.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
11.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
12.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
13.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
14.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
Enter these credits on TC-20S Sch. K line 19, or TC-65 Sch. K line 18, using the credit code above. Combine amounts for the same code.
Part 3
Utah Mineral Production Withholding Tax Credit Received on TC-675R
Producer EIN from
Mineral production withholding
TC-675R box “2”
Producer’s name from TC-675R box “1”
from TC-675R box “5”
1.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
2.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
3.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
4.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
5.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
6.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
7.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
8.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
9.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
10.
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ . 00
Total Utah mineral production withholding tax credit received on TC-675R....................................................
_ _ _ _ _ _ _ _ _ _ _ _ . 00
Enter total credit on Utah TC-20S Sch. K, line 19, or TC-65 Sch. K line 18, using credit code 46.

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