Form TC-675R Statement of Utah Tax Withheld on Mineral Production

3 Producer s Utah account number 4 Recipient s federal EIN (or SSN if an individual) 6 Utah tax withheld on mineral production 7 Utah mineral production gross payment subject to withholding not 9 Recipient entity type (check one) C Corporation S S Corporation P Partnership L Limited Liability Company O Limited Liability Partnership I Individual T Trust Estate or Fiduciary OffOffOffOffOffOffOff 1 Producer s name address city state and ZIP code 2 Producer s federal EIN 5 Utah mineral production gross payment to recipient 8 Recipient's name address city state ZIP code All Recipients For tax year: 20 If filing form TC 40 Utah Individual Income Tax Return enter the information from this TC 675R on form TC 40W Part 2 If production payments and Utah tax withheld are distributed to you by a partnership S corporation or trust a Utah Schedule K 1 (instead of a form TC 675R) should be furnished by the partnership S corporation or trust showing your allocated share of these amounts If you are a mineral producer and withhold tax amounts that are distributed to partners shareholders or beneficiaries you must furnish a Utah TC 675R to each partner shareholder or beneficiary recipient showing their share amounts of production payments and Utah tax withheld Issue separate forms TC 675R to each recipient to show these amounts If you are a Utah partnership or a Utah S corporation and you received a TC 675R or a Utah Schedule K 1 with a credit for Utah tax withheld on mineral production the credit must be distributed on the Schedule K 1 you send to your partners or shareholders Also list the withheld tax credit on TC 250 and attach the form to your partnership or S corporation return when filing Do not issue a separate form TC 675R to show these amounts Only producers licensed with the State of Utah for mineral production tax withholding may issue form TC 675R Individuals receiving Payments through Partnerships S Corporations and Trusts Producers Who are Partnerships S Corporations or Trusts Rev 7/12 Statement of Utah Tax Withheld on Mineral Production TC 675R TC 40 Utah Individual Income Tax Return TC 65 Utah Partnership Return and TC 20 Utah S Corporation Tax Return The amount of Utah tax withheld on mineral production shown in box 6 should be reported as a refundable tax credit on your Utah tax return The amount shown in box 7 is the amount of the payment made to a recipient that would have been subject to Utah withholding had the recipient not filed an exemption certificate in accordance with UC Section 59 6 102 1 Utah Mineral Production Gross Payment Not Subject to Utah Withholding Tax