Form Tc-41n - Schedule N - Pass-Through Entity Withholding Tax

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Schedule N
TC-41N 2013
41310
Pass-through Entity Withholding Tax
Employer Identification Number: _ _ _ _ __ __ ___________
An estate or trust with nonresident individual beneficiaries, resident business beneficiaries and/or nonresident business beneficiaries must
complete the information below to calculate the Utah income and to calculate the withholding tax for these beneficiaries.
Withholding Waiver Request
under §59-10-1403.2(5): If beneficiaries will pay the Utah tax on their own returns:
Enter “1” to request a waiver for ALL beneficiaries, enter “X” in column B and ”0” in column G for all beneficiaries .............
_ _ _
Enter “2” to request a waiver for SOME beneficiaries, enter “X” in column B and ”0” in column F for those beneficiaries requested
See Schedule N instructions for liability responsibilities when requesting a waiver.
A. Name of beneficiary
F. Income (loss)
G. 5% of income
H. Mineral production
J. Withholding tax
B. Withholding waiver for this beneficiary
attributable
F times 5% (.05)
withholding credit
to be paid by
(enter “X” in column B and “0” in Column G)
to Utah
(not less than 0)
this fiduciary
C. “X” if Dependent Beneficiary (enter “0” in col. G)
I. Upper-tier pass-
G less H and I
D. SSN/EIN of benficiary
through withholding
(not less than 0)
E. Beneficiary’s % of income
1) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
2) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
3) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
4) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
5) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
6) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
7) A. _ _________ _ _ _ _ _ _ _ _ _ _ _ F. __ _ _ _ _ _ _ . 00 G. _ _ _ _ _ _ _ _ . 00
H. __ _ _ _ _ _ _ . 00
J. _ ______ _ . 00
B. _ __
C. _ _ _
I. _ _ _ _ _ _ __ . 00
D. _ __________ E. _ _ _ _ _ _ _ _
Total Utah withholding tax to be paid by this fiduciary:
J. ____ ____ . 00
Enter here and on TC-41, line 31 and on Sch. K, line 15
Report the beneficiary’s pass-through withholding tax from column J on Schedule K-1, line 15.

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