Form Tc-41db - Statement Of Dependent Beneficiary Income - 2014

Download a blank fillable Form Tc-41db - Statement Of Dependent Beneficiary Income - 2014 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Tc-41db - Statement Of Dependent Beneficiary Income - 2014 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Statement of Dependent Beneficiary Income

TC-41DB

2014

Required by Utah Code §59-10-1402(17)

USTC ORIGINAL FORM

I, the undersigned, hereby declare that, for the taxable year ending _____ /_____ /20_____, I have or will claim the dependency exemption on my

federal income tax return under Internal Revenue Rode Section 151 for:

Name of dependent beneficiary

Dependent’s Social Security Number

I attest that the dependent named above is a beneficiary of a trust that is a pass-through entity, and the dependent’s federal adjusted gross income for

the taxable year does not exceed the basic standard deduction calculated under Internal Revenue Code Section 63 for the taxable year.

Signed

Date

Print name

Taxpayer’s Social Security Number

Instructions:

1 Give this form to the fiduciary estate or trust.

2 Keep a copy with your tax records.

3 Do not send a copy of this form to the Tax Commission.

4 This statement must be kept by the trustee of the trust and made available to the Tax Commission upon request (Utah Code §59-10-1403.2(6)).