Form Tc-941 Draft - Utah Withholding Return, Form Tc-941r - Utah Annual Withholding Reconciliation, Form Tc-941pc - Payment Coupon For Utah Withholding Tax Page 3
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2
3
4
5Utah State Tax Commission
TC-941R
94182
Utah Annual
Rev. 12/08
Withholding Reconciliation
Check here to close
Utah Account ID
9997
your account
Federal EIN
Name and address
Tax Period
Due Date (mmddyyyy)
Check if AMENDED
(replacement, not net difference)
1. Total number of W-2s and 1099s, or TC-675Rs issued
1
Total Utah wages, compensation, and distributions
2.
,
00
,
,
2
reported on W-2s and 1099s, or TC-675Rs
3. Total federal income tax withheld on W-2s and 1099s
00
,
,
3
00
4
,
4. Total Utah income tax withheld on W-2s and 1099s, or TC-675Rs
,
5. Utah tax withheld as reported on TC-941 return(s)
Jan - Mar
00
Jul - Sep
00
5a
,
5c
,
,
,
00
annual filers use 5d only
,
00
,
Apr - Jun
,
5b
,
Oct - Dec
5d
,
,
00
6
6. Add lines 5a through 5d and enter the total here
00
,
7. Subtract line 6 from line 4 and enter amount here (see instructions)
,
7
Paper
Electronically
How did you file your 1099s
Paper
Electronically
How did you file your W-2s
Paper
Electronically
If you check paper on any, include them with this reconciliation
How did you file your TC-675Rs
Under penalties provided by law, I declare, to the best of my knowledge, this return is true and correct.
Date
Phone no.
Signature
X
TC-941R Rev 12/08
USTC use only (box no.)
_________________
USTC use only
Return ENTIRE form, coupon and payment to the Utah State Tax Commission
Payment Coupon for Utah Withholding Reconciliation, TC-941RPC
TC-941RPC Rev. 12/08
W
Payment Due Date (mm/dd/yyyy)
Utah Account ID
Payment Period Ending (mm/dd/yyyy)
Tax Type
T
R
Account name: _______________________________________________
Amount Paid
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC
UT
84134-0600
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