Form Tc-41w - Utah Withholding Tax Schedule Page 2
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1
2TC-41W
Mineral Production and Pass-through Withholding Tax
41212
Rev. 12/12
Name of estate or trust
EIN
Part 2 - Utah Mineral Production Withholding Tax - TC-675R
Do not send TC-675Rs or Utah Schedules K-1 with return. Enter TC-675R or Schedule K-1 information below. Use additional TC-41Ws if needed.
1 Producer’s EIN from box “2” of TC-675R
4 Pass-through entity EIN if credit from partnership or S corporation, from
Utah Schedule K-1
2 Producer’s name from box “1” of TC-675R
5 Utah mineral withholding tax from box “6” of TC-675R or from
3 Producer’s Utah withholding number from box “3” of TC-675R
Utah Schedule K-1
* See illustration on page 26 *
(14 characters, ending in WMP, no hyphens)
First TC-675R or Utah Schedule K-1
Second TC-675R or Utah Schedule K-1
1
1
2
2
3
◄14 characters, no hyphens
3
◄14 characters, no hyphens
4
4
.00
.00
5
5
Third TC-675R or Utah Schedule K-1
Fourth TC-675R or Utah Schedule K-1
1
1
2
2
3
◄14 characters, no hyphens
3
◄14 characters, no hyphens
4
4
.00
.00
5
5
Enter total mineral production withholding tax from all lines 5 here and on TC-41A, Part 5, using code 46.
.00
Part 3 - Utah Pass-through Entity Taxpayer Withholding - Utah Schedule K-1
Do not send Utah Schedule(s) K-1 with return.
Enter information below. Use additional TC-4 Ws if needed.
1
Line explanations:
2 Name of pass-through entity from Utah Schedule K-1 box “B”
3 Utah withholding tax paid by pass-through entity
1 Pass-through entity EIN from Utah Schedule K-1 box “A”
First Utah Schedule K-1
Second Utah Schedule K-1
1
1
2
2
.00
.00
3
3
Third Utah Schedule K-1
Fourth Utah Schedule K-1
1
1
2
2
.00
.00
3
3
Enter total pass-through withholding tax from all lines 3 here and on TC-41A, Part 5, using code 43.
.00
Do not send TC-675Rs or Schedules K-1.
Use additional forms TC-41W, Part 2 or Part 3 if needed
Submit this page ONLY if data entered
Attach completed schedule to your 2012 Utah fiduciary return
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