Form Tc-941r - Ut Annual Mineral Production Withholding Reconciliation - 2015
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1
2original ustc form
Clear form
94182
This form is ONLY for use by
Utah State Tax Commission
MINERAL PRODUCERS.
TC-941R
Utah Annual Mineral Production
Employers must file the annual
Rev. 10/15
Withholding Reconciliation
9998
reconciliation electronically.
Utah Account ID
Check here to close
your account.
Federal EIN
Name and address
Tax Period (yyyy)
Due Date (mmddyyyy)
Check if AMENDED
(replacement, not net difference)
•
1. Total number of TC-675Rs issued
1
•
2. Total Utah distributions reported on TC-675Rs
2
.
•
3. Tax Commission use only
3
.
•
4. Total Utah income tax withheld on TC-675Rs
4
.
5. Utah tax withheld as reported on TC-941 return(s)
•
•
Jan - Mar
5a
Jul - Sep
5c
.
.
•
•
Apr - Jun
5b
Oct - Dec
5d
.
.
6. Add lines 5a through 5d and enter the total here
6
.
7. Subtract line 6 from line 4 and enter amount here (see instructions)
7
.
File online at taxexpress.utah.gov.
Under penalties provided by law, I declare to the best of my knowledge this return is true and correct.
Signature
Date
Phone
X
•
USTC use only (box no.)
•
USTC use only
Return ENTIRE form, coupon and payment to the Utah State Tax Commission
Payment Coupon for Mineral Production Withholding Reconciliation, TC-941RPC
TC-941RPC Rev. 6/15
W
Tax Type
Payment Period Ending (mmddyyyy)
Payment Due Date (mmddyyyy)
Utah Account ID
Withholding
T
R
Account name: _______________________________________________
Amount Paid
Do not send cash. Do not staple check
to this coupon. Detach any check stub.
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC
UT
84134-0600
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