Form 1042 - Annual Withholding Tax Return For U.s. Source Income Of Foreign Persons - 2017 Page 2

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2
Form 1042 (2017)
Page
63
Total tax reported as withheld or paid by withholding agent on all Forms 1042-S and 1000:
a Tax withheld by withholding agent
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63a
b Tax withheld by other withholding agents:
(1) For payments other than substitute dividends .
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63b(1)
63b(2)
(2) For substitute dividends .
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c Adjustments to withholding:
(1) Adjustments to overwithholding
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63c(1)(
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63c(2)
(2) Adjustments to underwithholding .
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d
Tax paid by withholding agent .
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63d
e
Total tax reported as withheld or paid (Add lines 63a-d) .
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63e
64
Total net tax liability
a Adjustments to total net tax liability
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64a
b Total net tax liability under chapter 3 .
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64b
c Total net tax liability under chapter 4 .
64c
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d Excise tax on specified federal procurement payments (Total payments made x 2%) .
64d
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e Total net tax liability (Add lines 64a-d) .
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64e
65
Total paid by electronic funds transfer (or with a request for extension of time to file):
a Total paid during calendar year .
65a
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b Total paid during subsequent year .
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65b
66
Enter overpayment applied as credit from 2016 Form 1042
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66
67
Credit for amounts withheld by other withholding agents:
a For payments other than substitute dividend payments .
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67a
b For substitute dividend payments .
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67b
68
Total payments. Add lines 65 through 67 .
68
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69
69
If line 64e is larger than line 68, enter balance due here .
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70a Enter overpayment attributable to overwithholding on U.S. source income of foreign persons .
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70a
b Enter overpayment attributable to excise tax on specified federal procurement payments
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70b
71
Apply overpayment (sum of lines 70a and 70b) to (check one):
Credit on 2018 Form 1042
or
Refund
Section 2
Reconciliation of Payments of U.S. Source FDAP Income
1
1
Total U.S. source FDAP income required to be withheld upon under chapter 4 .
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2
Total U.S. source FDAP income required to be reported under chapter 4 but not required to be
withheld upon under chapter 4 because:
a Amount of income paid to recipients whose chapter 4 status established no withholding is required .
2a
b Amount of excluded nonfinancial payments .
2b
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c Amount of income paid with respect to grandfathered obligations .
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2c
d Amount of income effectively connected with the conduct of a trade or business in the U.S.
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2d
e Total U.S. source FDAP income required to be reported under chapter 4 but not required to be withheld
upon under chapter 4 (Add lines 2a-d) .
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2e
3
Total U.S. source FDAP income reportable under chapter 4 (Add lines 1 and 2e)
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3
4
4
Total U.S. source FDAP income reported on all Forms 1042-S (from line 62a, (b)(1), and (b)(2)) .
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5
Total variance, subtract line 3 from line 4, if amount other than zero, provide explanation on line 6 .
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6
Section 3
Potential Section 871(m) Transactions
Check here if any payments (including gross proceeds) were made by the withholding agent under a potential section 871(m)
transaction, including a notional principal contract or other derivatives contract that references (in whole or in part) a U.S. stock or
other underlying security. See instructions
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Section 4
Dividend Equivalent Payments by a Qualified Derivatives Dealer (QDD)
Check here if any payments were made by a QDD .
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If box is checked, you must attach a statement. See instructions for requirements.
1042
Form
(2017)

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