Form Tc-41 - Utah Fiduciary Income Tax Return - 2016 Page 9
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15Schedule K-1 - Beneficiary’s Share of Income, Deductions and Credits
TC-41K-1
41609
2016
EIN or SSN
Estate/trust name
USTC ORIGINAL FORM
Estate or Trust Information
Beneficiary’s Share of Utah Income, Deductions and Credits
.00
1a
Utah U.S. government interest income
.00
A Estate or trust EIN or SSN:
1b
Utah taxable municipal bond interest income
.00
1c
Utah other interest income
.00
B Estate or trust name
2
Utah ordinary dividends
.00
3
Utah net short-term capital gain
.00
4
Utah net long-term capital gain
Fiduciary Information
.00
5
Utah portfolio and nonbusiness income
.00
C Fiduciary name, address, city, state, and ZIP code
6
Utah ordinary business income
.00
7
Utah net rental real estate income
.00
8
Utah other rental income
9
Utah directly apportioned deductions (describe)
.00
Beneficiary Information
.00
.00
D Beneficiary’s EIN or SSN
.00
E Beneficiary’s name, address, city, state, and ZIP code
.00
10
Estate tax deduction
11
Final year Utah deductions (describe)
.00
.00
.00
.00
F
Beneficiary’s phone number
G Percent of Utah income distributed to
12
Other Utah information
.00
the beneficiary
.00
H Dependent Beneficiary - enter “X”
.00
“Statement of Dependent Beneficiary Income” on file with trustee
.00
(See Schedule N instructions for definition of dependent beneficiary.)
Other Information
13
Utah nonrefundable credits allocated to beneficiary
Name of credit
Code
Amount
.00
.00
.00
.00
14
Utah refundable credits allocated to beneficiary
Name of Credit
Code
Amount
.00
.00
.00
Tax Commission Use Only:
.00
.00
15
Utah tax withheld on behalf of beneficiary
“X” if withholding waiver applied for
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