Form D-41 - Fiduciary Income Tax Return - 2012 Page 2
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1
2D-41 PAGE 2
*120410120002*
Name
SSN or FEIN
Tax and payments
See instructions.
.
$
00
13 Tax on fiduciary income
13
.
$
00
14
14
Credit for taxes paid to other states
Credit may not exceed amount on Line 13. See
instructions, page 6. Attach copy of state return.
.
15
Net tax on fiduciary income
$
00
Line 13 minus Line 14.
15
16a
.
16a
Income tax withheld
$
00
.
16b
16b
2012 estimated fiduciary income tax payments
$
00
.
$
00
17
17
Payments made with extension of time to file
from FR-127F calculation, Line 3
.
$
00
18
18
If this is an amended 2012 return, payments made with original 2012 D-41
.
$
00
19
Total payments
19
Add Lines 16a–18.
If Line 19 is more than Line 15 subtract Line 15 from Line 19.
If Line 19 is less than Line 15 subtract Line 19 from Line 15.
23
Amount owed
20
.
Amount of
$
00
.
$
00
overpayment
21
Amount, if any, to be applied to 2013 estimated tax
Payment
Attach check or money order to the D-41P voucher only; make it payable
.
$
00
to: DC Treasurer. Write the estate or trust’s SSN, and/or trust’s FEIN and
22
Refund
Subtract
“2012 D-41” on the payment.
.
$
00
Line 21 from Line 20
Will this refund you requested go to an account outside the U.S.?
Yes
No
See pg. 3.
Signature
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct.
Declaration of paid preparer is based on the information available to the preparer.
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Signature of paid preparer
Paid preparer’s PTIN
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Send your signed and completed original return to:
Office of Tax and Revenue
PO Box 96153
Washington DC 20090-6153
2012 D-41 P2
Revised 11/12
Fiduciary Income Tax Return
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