Form 1042 - Annual Withholding Tax Return For U.s. Source Income Of Foreign Persons - 2014 Page 3

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Form 1042 (2014)
Page
63
Total tax reported as withheld or assumed on all Forms 1042-S and 1000:
a Taxes withheld by withholding agent .
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63a
b Taxes withheld by other withholding agents:
(1) For payments other than substitute dividends .
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63b(1)
63b(2)
(2) For substitute dividends .
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c Reimbursements
63c
d Tax assumed by withholding agent
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63d
e Total tax reported as withheld or assumed (Add lines 63a-d) .
63e
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64
Total net tax liability
a Adjustments of underwithheld tax on corporate distributions made during the calendar year
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64a
b Total net tax liability under chapter 3 .
64b
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c Total net tax liability under chapter 4 .
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64c
d Excise tax on specified federal procurement payments (Total payments made x 2%) .
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64d
e Total net tax liability (Add lines 64 a-d) .
64e
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65
65
Total paid by electronic funds transfer (or with a request for extension of time to file) .
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66
Enter overpayment applied as credit from 2013 Form 1042
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66
67
Credit for amounts withheld by other withholding agents:
a For payments other than substitute dividend payments .
67a
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b For substitute dividend payments .
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67b
68
Total payments. Add lines 65 through 67 .
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68
69
69
If line 64e is larger than line 68, enter balance due here .
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70a Enter overpayment attributable to overwithholding on U.S. source income of foreign persons .
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70a
b Enter overpayment attributable to excise tax on specified federal procurement payments
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70b
71
Apply overpayment (sum of lines 70a and 70b) to (check one):
Credit on 2015 Form 1042
or
Refund
Section 2
Reconciliation of Payments of U.S. Source FDAP Income-Optional
1
Total U.S. source FDAP income required to be withheld upon under chapter 4 .
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1
2
Total U.S. source FDAP income required to be reported under chapter 4 but not required to be
withheld upon under chapter 4 because:
a Amount of income paid to recipients whose chapter 4 status established no withholding is required .
2a
b Amount of excluded nonfinancial payments (see instructions) .
2b
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c Amount of income paid with respect to grandfathered obligations .
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2c
d Amount of income effectively connected with the conduct of a trade or business in the U.S.
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2d
e Amount of excluded offshore payment .
2e
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f
Total U.S. source FDAP income required to be reported under chapter 4 but not required to be withheld
upon under chapter 4 (Add lines 2a-e) .
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2f
3
Total U.S. source FDAP income reportable under chapter 4 (Add lines 1 and 2f)
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3
4
4
Total U.S. source FDAP income reported on all Forms 1042-S (from line 62a, (b)(1), and (b)(2)) .
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5
Total variance, subtract line 3 from line 4, if amount other than 0 provide explanation on line 6 .
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5
6
Notional principal contract payments and other payments on derivative contracts that reference (in
Section 3
whole or in part) a U.S. security
Check here if any payments (including gross proceeds) were made by the withholding agent under notional principal contracts
or other derivatives contracts that reference (in whole or in part) a U.S. security (see instructions) .
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1042
Form
(2014)

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