Form Tc-941 - Utah Withholding Return

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Utah State Tax Commission
TC-941
94181
Utah Withholding Return
Rev. 3/09
Check here to stop
Utah Account ID
9998
receiving paper forms
Check here to close
Federal EIN
Name and address
your account
Tax Period
From (mmddyyyy)
To (mmddyyyy)
Due Date (mmddyyyy)
Check if AMENDED
(replacement, not net difference)
00
1. Utah wages, compensation, and distributions for this period
1
00
2. Federal tax withheld this period for Utah employees
2
00
3. Utah tax withheld this period
3
For payment instructions, go to
tax.utah.gov
or use TC-941PC (coupon).
Under penalties provided by law, I declare, to the best of my knowledge, this return is true and correct.
Phone no.
Signature
Date
X
_________________
USTC use only

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