Form 1042 - Annual Withholding Tax Return For U.s. Source Income Of Foreign Persons - 1992

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1042
Annual Withholding Tax Return for
OMB No. 1545-0096
Form
U.S. Source Income of Foreign Persons
Department of the Treasury
See separate instructions for Forms 1042 and 1042S.
Internal Revenue Service
Name of withholding agent
Taxpayer identification number
For IRS Use Only
Number, street, and room or suite no. (If a P.O. box, see page 4 of the instructions)
CC
FD
RD
FF
City or town, state, and ZIP code
CAF
FP
CR
I
EDC
SIC
If you will not be liable for returns in the future, check here
Enter date final income paid
Check here if you made quarter-monthly deposits using the 90% rule (see Deposit Requirements on page 3 of the instructions)
Record of Federal Tax Liability
(Do not show Federal tax deposits here.)
Deposit
Tax liability for period
Deposit
Tax liability for period
Deposit
Tax liability for period
Line
Line
Line
period
(including any taxes assumed
period
(including any taxes assumed
(including any taxes assumed
period
No.
No.
No.
ending
on Form(s) 1000)
ending
on Form(s) 1000)
on Form(s) 1000)
ending
1
7
21
7
41
7
2
15
22
15
42
15
Jan.
May
Sept.
3
22
23
22
43
22
4
31
24
31
44
30
Jan. total
May total
Sept. total
5
25
45
6
7
26
7
46
7
7
15
27
15
47
15
June
Oct.
Feb.
8
22
28
22
48
22
9
29
29
30
49
31
Oct. total
10
Feb. total
30
June total
50
11
7
31
7
51
7
12
15
32
15
52
15
Mar.
July
Nov.
13
22
33
22
53
22
14
31
34
31
54
30
Nov. total
July total
15
Mar. total
35
55
16
7
36
7
56
7
17
15
37
15
57
15
Apr.
Aug.
Dec.
18
22
38
22
58
22
19
30
39
31
59
31
Apr. total
Aug. total
20
40
60
Dec. total
61
Total tax liability (add monthly total lines from above)
61
62
Form(s) 1042S:
a
Number filed on magnetic tape
b
Number filed on paper
63
Form(s) 1042S and 1000:
a
Gross income paid
b
Taxes withheld or assumed
64
Total paid by Federal tax deposit coupons (or with a request for
64
an extension of time to file) for 1992
65
65
Enter overpayment applied as a credit from 1991 Form 1042
66
66
Total payments. Add lines 64 and 65
67
67
If line 61 is larger than line 66, enter BALANCE DUE here. (If $200 or more, use FTD coupon.)
68
68
If line 66 is larger than line 61, enter OVERPAYMENT here
69
Apply overpayment on line 68 to (check one):
Credit on 1993 Form 1042; or
Refund
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
Please
belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer has any knowledge.
Sign
Here
Your signature
Date
Capacity in which acting
Date
Preparer’s social security no.
Preparer’s
Paid
Check if
signature
self-employed
Preparer’s
Firm’s name (or
E.I. No.
Use Only
yours if self-employed)
ZIP code
and address
1042
For Paperwork Reduction Act Notice, see page 1 of the instructions.
Cat. No. 11384V
Form
(1992)

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