Form Pw-2 - Wisconsin Nonresident Partner, Member, Shareholder, Or Beneficiary Withholding Exemption Affidavit - 2012
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1
2Form
2012
Wisconsin Nonresident Partner,
PW-2
Member, Shareholder, or Beneficiary
Withholding Exemption Affidavit
Note: This form is due within one month or two months after the close of the pass-through entity’s taxable year. See instructions for details.
Part 1: Information for Department of Revenue
Pass-Through Entity Information
Pass-Through Entity Name
Entity’s Identification Number (Enter one)
FEIN
SSN
Number and Street
City
State
ZIP (+ 4 digit suffix if known)
Person to Contact Regarding This Information
Telephone Number
This pass-through entity files as a (check one):
Last Day of Entity’s Taxable Year
Partnership
Tax-option (S) Corporation
Estate or Trust
D
D
Y
Y
M
M
C
C
(if nonresident is a disregarded entity, grantor trust, or combined return filer).
Reporting Entity
Taxpayer Name
Taxpayer’s Identification Number (Enter one)
SSN
FEIN
Nonresident Information
Taxpayer Name
Taxpayer’s Identification Number (Enter one)
SSN
FEIN
Number and Street
City
State
ZIP (+ 4 digit suffix if known)
Person to Contact Regarding This Information
Telephone Number
Form that you will use to report your income or franchise tax for this period (check one):
1NPR
1CNP
1CNS
2
4
4T
5
5S
3
Nonresident’s Last Day of 2012 Taxable Year
Amount of income from the pass-through entity:
Amount of credits from the pass-through entity:
D
D
Y
Y
M
M
C
C
Reason for Exemption (check one):
I have paid or carried forward Wisconsin estimated tax payments applicable to this period, in the total amount of
1.
. If this amount is less than the amount of tax (after credits) attributable to income from the pass-
through entity, an explanation of the difference is attached. (Attach explanation.)
I have a Wisconsin source: (check boxes that apply)
a. net operating loss carryforward
b. suspended loss carryfor-
2.
ward, or
c. both a and b, which exceeds my income from the pass-through entity, and I have filed Wisconsin income or
franchise tax returns for each year of losses that produced the carryforward.
I incurred Wisconsin source losses from other sources in the current taxable year which exceed my total Wisconsin source
3.
income. Details of the losses are provided below. (Attach additional sheets if necessary.)
Explanation, including name, address, and FEIN of any other pass-through entities which are the
Loss amount
source of Wisconsin losses
I have Wisconsin credits or credit carryforwards from other sources, which exceed my total Wisconsin tax liability (before cred-
4.
its). Details of these credits are provided below. (Attach additional sheets if necessary.)
Source of credit, including name, address, and FEIN of any other pass-through entities
Credit type and amount
which are the source of Wisconsin credits
The nonresident filing this affidavit is itself a pass-through entity, and will withhold taxes on all income allocable to its nonresident
5.
partners, members, shareholders, or beneficiaries, unless an exemption applies.
IC-005
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