Form Db020w-Nr - Payment Of Indiana Withholding Tax For Nonresident Shareholders, Partners, Or Beneficiaries Of Trusts And Estates

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FORM DB020W-NR
State Form
49100
Payment of Indiana Withholding Tax for Nonresident
(R9 / 8-11)
Shareholders, Partners, or Beneficiaries of Trusts and Estates
INDIANA TAXPAYER IDENTIFICATION NUMBER:
TAX PERIOD ENDING:
(IF NONE, INDICATE FEDERAL ID NUMBER BELOW)
LOCATION
M
M
Y
Y
Y
Y
(CODE-DEPT. USE ONLY)
.
TAXPAYER'S NAME AND ADDRESS:
A.
NAME
TOTAL AMOUNT OF PAYMENT
STREET
.
B.
CITY
STATE
ZIP CODE
TOTAL AMOUNT DUE
DO NOT SEND CASH
ENTER YOUR FEDERAL IDENTIFICATION NUMBER:
MAKE CHECK OR MONEY ORDER
IS THIS A ONE-TIME ANNUAL
IN U.S. FUNDS PAYABLE TO:
DISTRIBUTION?
YES
NO
INDIANA DEPARTMENT OF REVENUE
MAIL COMPLETED FORM TO:
X
INDIANA DEPARTMENT OF REVENUE
AUTHORIZED SIGNATURE
P.O. BOX 7228
DAYTIME TELEPHONE NUMBER (
)
DATE
INDIANAPOLIS, IN 46207
DO NOT USE THIS FORM FOR REPORTING PAYROLL WITHHOLDING TAX
Use this form (if you have not established a separate non-resident
Line B: Enter the total withholding tax due for the ending
withholding account) to remit Indiana state income tax withholding
tax period indicated. Do not include penalty or interest. If
on annual income distributions to nonresident shareholders, non-
the remittance is equal to the total amount due, the amount
resident partners, or nonresident beneficiaries of trusts and estates.
reported on A and B should be the same.
Also, include county income tax withholding for an Indiana tax-
Sign and date the form. List your daytime telephone number
adopting county if on January 1 of the tax year, this was the non-
and enter your federal identification number for prompt
resident's principal place of business or employment. If already
processing of this form. Upon proper registration, the
registered as a nonresident withholding agent, use the designated
Department will mail an Indiana nonresident withholding
Form WH-1 (Indiana Withholding Tax Voucher).
return coupon(s) for the next tax year for use in filing the
required monthly, quarterly, or annual withholding returns.
Payment is generally due within 30 days following the end of the
tax year or quarter (if the liability for a quarterly period exceeds
Note: Form WH-3 (Annual Withholding Reconciliation and
$150). However, if an entity pays or credits amounts to its non-
Transmittal Form) and state copies of Form WH-18 (Indiana
resident shareholders, partners, or beneficiaries one time each
Miscellaneous Withholding Tax Statement) must be filed an-
year, the withholding payment is due on or before the 15th day of
nually on or before the end of February. The Department may
the third month after the end of the taxable year.
permit an entity paying or crediting amounts to its nonresidents
only one time each year an extension of time to file Form WH-3,
Caution: This form will establish a separate nonresident with-
until March 15 following the close of the calendar year in which
holding account followed by a letter requesting any additional
the taxable year ends. However, the payment of withholding tax
information needed to complete the registration.
on the one-time annual distribution is required to have been
remitted (and the withholding statement provided to the payee)
Complete Form DB020W-NR by entering the assigned
2 1/2 months after the end of the entity’s taxable year.
Indiana taxpayer identification number. Indicate the with-
holding liability reporting period by entering a six-digit number
An extension of time to file Form WH-3 may be requested in
corresponding to the ending month and year in the blocks
writing if the information on the distributive share of income
provided.
reportable on Form WH-18 is not available by the due date.
Enter your full name and address in the space provided.
However, an extension of time to file Form WH-3 does not
extend the time to pay withholding tax due on Form WH-1 or
Line A: Enter the withholding tax paid with this return for
DB020W-NR.
the tax period indicated. Do not include penalty and interest
if paying late. The Department will calculate and bill for
If you have any questions regarding this form or the withholding tax,
penalty and interest if payment is received after the due date.
please call the Indiana Department of Revenue, Tax Administration
at (317) 232-0129.
*24100000000*
24100000000

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