Form Tc-20s, Schedule K Shareholders' Pro Rata Share Items Page 4

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TC-20S, Schedule N
TC-20S N 2012
20228
Pass-through Entity Withholding Tax
Employer Identification Number: _ ___________ _______
An S corporation with nonresident individual shareholders, resident business shareholders and/or nonresident business shareholders must
complete the information below to calculate the Utah withholding tax for these shareholders.
Withholding Waiver Request
under §59-10-1403.2(5): If shareholders will pay the Utah tax on the own returns:
Enter “1” to request a waiver for ALL shareholders, enter “X” in column B and ”0” in column F for all shareholders.............
_ _ _
Enter “2” to request a waiver for SOME shareholders, enter “X” in column B and ”0” in column F for those shareholders requested
See Schedule N instructions for liability responsibilities when requesting a waiver.
A. Name of shareholder
E. Income (loss)
F. 5% of income
G. Mineral production
I. Withholding tax
B. Withholding waiver for this shareholder
attributable
(E times .05 –
withholding credit
to be paid by
(enter “X” in column B and “0” in Column F)
to Utah
not less than 0)
this corporation
C. SSN/EIN of shareholder
H. Upper-tier pass-
(F less G and H –
D. % of ownership in S corp by shareholder
through withholding
not less than 0)
1) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
2) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
3) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
4) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
5) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
6) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
7) A. ____________ _ __ __ __ __ E. _ __ __ __ _ . 00 F. __ _ _ _ _ _ _ . 00
G. _ _ _ _ _ _ _ _ . 00
I. _ __ ___ __ . 00
B. ___
H. _ _ _ _ _ _ _ _ . 00
C. __________ _ D. _ __ __ _ __
Total Utah withholding tax to be paid by this corporation:
I. __ __ __ __ . 00
Enter here and on TC-20S, Sch. A, line 14 and on Sch. K, line 20
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
Clear form
Report the shareholder’s pass-through withholding tax from column I on Schedule K-1, line 20.

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