Form 1041-N - U.s. Income Tax Return For Electing Alaska Native Settlement Trusts
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41041-N
U.S. Income Tax Return for Electing
Form
Alaska Native Settlement Trusts
(Rev. December 2017)
OMB No. 1545-1776
Department of the Treasury
Go to for instructions and the latest information.
Internal Revenue Service
▶
For calendar year
or short year beginning
, 20
, and ending
, 20
.
Part I
General Information
1
2
Employer identification number
Name of trust
3a
Name and title of trustee
4 Name of sponsoring Alaska Native Corporation
3b
Number, street, and room or suite no. (If a P.O. box, see the instructions.)
3c
City or town, state, and ZIP code
5
Was Form 1041 filed in the prior year?
Yes
No
6 Check applicable boxes:
Amended return
Final return
Change in fiduciary’s name
Change in fiduciary’s address
Part II
Tax Computation
1a Interest income .
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1a
b Tax-exempt interest. Don’t include on line 1a .
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1b
2 a Total ordinary dividends .
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2a
b Qualified dividends (see instructions)
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2b
3
3
Capital gain or (loss) (Schedule D)
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4
Other income. List type and amount
4
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5
Total income. Combine lines 1a, 2a, 3, and 4 .
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5
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6
Taxes .
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6
7
Trustee fees .
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7
8
8
Attorney, accountant, and return preparer fees
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9
Other deductions not subject to the 2% floor (attach schedule) .
9
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10
Allowable miscellaneous itemized deductions subject to the 2% floor .
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10
11
Exemption (see instructions)
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11
12
Total deductions. Add lines 6 through 11 .
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12
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13
Taxable income. Subtract line 12 from line 5 .
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13
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14
Tax. If line 13 is a (loss), enter -0-. Otherwise, see the instructions and check the
Multiply line 13 by 10% (0.10) or
Schedule D
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applicable box:
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14
Credits (see instructions). Specify
15
15
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16
Subtract line 15 from line 14
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16
17
Reserved .
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17
18
Total tax. Add line 16 and line 17. See instructions .
18
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19
19
Payments. See instructions .
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20
Tax due. If line 19 is smaller than line 18, enter amount owed .
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20
21
Overpayment. If line 19 is larger than line 18, enter amount overpaid .
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21
22
Amount of line 21 to be: a Credited to next year’s estimated tax
b Refunded
22
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Part III
Other Information
1
During the tax year, did the trust receive assets from a sponsoring Alaska Native Corporation? If “Yes,” see the
Yes No
instructions for the required attachment .
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2
During the year, did the trust receive a distribution from, or was it the grantor of, or the transferor to, a foreign trust?
3
At any time during the calendar year, did the trust have an interest in or a signature or other authority over a
financial account in a foreign country (such as a bank account, securities account, or other financial account)? See
the instructions for exceptions and filing requirements for FinCEN Form 114.
If “Yes,” enter the name of the foreign country
▶
4
Was the trust a specified domestic entity required to file Form 8938 for the tax year (see the Instructions for Form 8938)?
5
To make a section 643(e)(3) election, complete Schedule D and check here. See instructions .
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than trustee) is based on all information of which preparer has any knowledge.
Sign
Also, under section 646(c)(2) of the Internal Revenue Code, if this is the initial Form 1041-N filed for the above-named Alaska Native Settlement Trust,
signing and filing this return will serve as the statement by the trustee electing to treat such trust as an Electing Alaska Native Settlement Trust.
Here
May the IRS discuss this return
with the preparer shown below
Signature of trustee or officer representing trustee
Date
Yes
No
(see instr.)?
Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm’s EIN
▶
▶
Firm’s address
Phone no.
▶
1041-N
For Paperwork Reduction Act Notice, see the Instructions for Form 1041-N.
Form
(Rev. 12-2017)
Cat. No. 32234Q
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