Clear form
TC-41K-1
Beneficiary’s Share of Income, Deductions, and Credits
Rev. 12/12
41209
Taxpayer’s SSN
Taxpayer’s name
Estate or trust information
Beneficiary’s Share of Utah Income, Deductions and Credits
.00
A. Estate or trust EIN or SSN ______________________________
1a. Utah U. S. government interest income
.00
1b. Utah municipal bond interest income
B. Estate or trust name
.00
1c. Utah other interest income
.00
2. Utah ordinary dividends
Fiduciary information
.00
3. Utah net short-term capital gain
C. Fiduciary’s name, address, city, state, and ZIP code
.00
4. Utah net long-term capital gain
.00
5. Utah other portfolio and nonbusiness income
.00
6. Utah ordinary business income
.00
7. Utah net rental real estate income
Beneficiary information
.00
8. Utah other rental income
D. Beneficiary’s SSN or EIN ____________________________
9. Utah directly apportioned deductions (describe)
E. Beneficiary’s name, address, city, state, and ZIP code
.00
.00
.00
.00
.00
F. Beneficiary’s phone number __________________________
10. Estate tax deduction
G. Percent of Utah income _____________________________
11. Final year Utah deductions (describe)
.00
Other information
.00
.00
.00
12. Other Utah information
.00
.00
.00
.00
For Utah State Tax Commission Use Only
13. Utah nonrefundable credits allocated to beneficiary
Name of credit
Code
Credit amount
.00
.00
.00
.00
14. Utah refundable credits allocated to beneficiary
Name of credit
Code
Credit amount
.00
.00
.00
.00