Form TC-41W Utah Withholding Schedules

14 characters no hyphens 14 characters no hyphens 14 characters no hyphens 14 characters no hyphens 4 Off (14 characters ending in WMP no hyphens) * See illustration on page 26 * 1 Pass through entity EIN from Utah Schedule K 1 box A 3 Utah withholding tax paid by pass through entity 1 Producer s EIN from box 2 of TC 675R 4 Pass through entity EIN if credit from partnership or S corporation from Utah Schedule K 1 2 Producer s name from box 1 of TC 675R 5 Utah mineral withholding tax from box 6 of TC 675R or from 3 Producer s Utah withholding number from box 3 of TC 675R Utah Schedule K 1 4 Off 41211 Rev 12/12 41212 Mineral Production and Pass through Withholding Tax Rev 12/12 Attach completed schedule to your 2012 Utah fiduciary return Do not send TC 675Rs or Schedules K 1 Do not send TC 675Rs or Utah Schedules K 1 with return Enter TC 675R or Schedule K 1 information below Use additional TC 41Ws if needed Do not send Utah Schedule(s) K 1 with return Enter information below Use additional TC 41Ws if needed Do not send W 2s or 1099s Enter this total on form TC 41 page 2 line 32 Enter total mineral production withholding tax from all lines 5 here and on TC 41A Part 5 using code 46 Enter total pass through withholding tax from all lines 3 here and on TC 41A Part 5 using code 43 Enter total Utah withholding tax from all lines 7 First TC 675R or Utah Schedule K 1 First Utah Schedule K 1 First W 2 or 1099 Second W 2 or 1099 Fourth TC 675R or Utah Schedule K 1 1 Fourth Utah Schedule K 1 Line explanations: 1 Employer payer ID number (from W 2 box b or 1099) 2 Utah withholding ID number (from W 2 box 15 or 1099) 3 Employer payer name and address (from W 2 box c or 1099) 4 Enter X if reporting Utah withholding from form 1099 5 Employee s Social Security number (from W 2 box a or 1099) 6 Utah wages/income (from W 2 box 16 or 1099) 7 Utah withholding tax (from W 2 box 17 or 1099) / (14 characters ending in WTH no hyphens) / * See illustration on page 25 * IMPORTANT Do not send your W 2s and 1099s with your return only Instead enter W 2 and 1099 information below but if there is Utah withholding on the form Use additional TC 41W forms if you have more than four W 2s and/or 1099s with Utah withholding tax Enter mineral production withholding from TC 675R or Utah Schedule K 1 in Part 2 of TC 41W; enter pass through entity withholding in Part 3 of TC 41W Line explanations: 2 Name of pass through entity from Utah Schedule K 1 box B Name of estate or trust Part 1 Utah Withholding Tax Schedule Part 2 Utah Mineral Production Withholding Tax TC 675R Part 3 Utah Pass through Entity Taxpayer Withholding Utah Schedule K 1 Second TC 675R or Utah Schedule K 1 Second Utah Schedule K 1 Submit this page ONLY if data entered TC 41W Third TC 675R or Utah Schedule K 1 Third Utah Schedule K 1 Third W 2 or 1099 Fourth W 2 or 1099 Use additional forms TC 41W Part 2 or Part 3 if needed