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Utah State Tax Commission
For Annual Withholding Reconciliation
Tax year for this report
Check box if
When To Use This Form
If your business changed entity types or merged with another company during the tax year and lines 4 and 6 of your Utah
Annual Withholding Reconciliation, form TC-941R, do not balance, you must file this form explaining the discrepancy and
reconciling the withholding tax returns with the W-2s (or other withholding forms) issued by your company.
Federal employer identification no.
Utah withholding account number
Check the reason your W-2s and/or TC-941R are being filed for more than one Utah Employer Withholding Account.
Business merged with another business
Business changed from a sole proprietorship to a partnership, LLC or corporation
Business changed from a partnership to a sole proprietorship, LLC or corporation
Business changed from a LLC to a sole proprietorship, partnership or corporation
Business changed from a corporation to a sole proprietorship, partnership or LLC
Other (explain): ______________________________________________________________________________
Yearly total tax withheld as
Utah withholding tax as
Utah employer withholding
Difference in amounts reported
reported on TC-941R, line 6
reported on TC-941R, line 4
(subtract Column C from Column B)
Totals (Column D must equal zero)
Under penalties provided by law, I declare, to the best of my knowledge, this report is true and correct.
Instructions For Reconciliation Calculation Above
Enter the Utah employer withholding account number of each account for which you filed quarterly Utah Withholding Returns,
TC-941, during the year.
Enter the sum of the withholding reported on TC-941R, line 6 for each account number.
Enter the total withholding reported on the TC-941R, line 4 for each account number.
and enter the result. The total of
. If the result is not zero, the
following are possible explanations.
1. You may have made an error. Check the amounts on TC-941s and TC-941R to ensure you entered the correct figures.
2. You may have underpaid the withholding tax. If the withholding reported in
is greater than the sum of the withholding in
(i.e., the difference is a negative number in Column D), you have underpaid.
3. You may have overpaid the withholding tax. If the withholding reported in
is less than the sum of the withholding in
(i.e., the difference is a positive number in Column D), you have overpaid.
You may pay the additional tax or request the refund by filing an amended form TC-941 for the period(s) you either underpaid or overpaid.