00 00
14 characters no hyphens
14 characters no hyphens
(14 characters ending in WMP no hyphens)
(14 characters ending in WTH no hyphens)
(enter EIN from Utah Schedule K 1)
* See illustration instructions *
* To the extent previously deducted
<14 characters no hyphens
<14 characters no hyphens
01 At home parent credit
02 Qualified sheltered workshop credit
04 Capital gain transactions credit 22 Medical Care Savings Account (MSA) credit
05 Clean fuel vehicle credit
06 Historic preservation credit
07 Enterprise zone credit
08 Low income housing credit
1 Employer payer ID number (from W 2 box b or 1099)
1 Pass through entity EIN from Utah Schedule K 1 box A
1 Producer s EIN from box 2 of TC 675R
10 Recycling market dev zone credit
12 Research activities credit
13 Carryover of mach /equip research credit
17 Tax paid to another state (attach TC 40S)
18 Retirement tax credit (attach TC 40C)
19 Live organ donation expenses credit
2 Name of pass through entity from Utah Schedule K 1 box B
2 Producer s name from box 1 of TC 675R
2 Utah withholding ID number (from W 2 box 15 or 1099)
20 Utah Educational Savings Plan (UESP) credit
21 Renewable residential energy systems credit
23 Health benefit plan credit
24 Qualifying solar project credit
25 Combat related death credit
26 Gold and silver coin sale credit
27 Veteran employment tax credit
3 Employer payer name and address (from W 2 box c or 1099)
3 Producer s Utah withholding ID # from box 3 of TC 675R
3 Utah withholding tax paid by pass through entity
39 Renewable commercial energy systems
4 Enter X if reporting Utah withholding from form 1099
4 Pass through entity EIN if credit from partnership or S corporation
40 Targeted business tax credit
40304
40305
40309
40310
41 Special needs adoption credit
47 Agricultural off highway gas/undyed diesel
48 Farm operation hand tools
5 Employee s SSN (from W 2 box a or 1099)
5 Utah mineral production withholding tax from box 6 of TC 675R or
51 Lump sum distribution
53 Medical Savings Account (MSA) addback*
54 Utah Educational Savings Plan (UESP) addback *
55 Reimbursed adoption expenses *
56 Child's income excluded from parent's return
57 Municipal bond interest
6 Utah wages/income (from W 2 box 16 or 1099)
60 Untaxed income of a resident trust
61 Untaxed income of a nonresident trust
69 Equitable adjustments attach explanation
7 Utah withholding tax (from W 2 box 17 or 1099)
71 Interest from U S Government Obligations
77 Native American income
78 Railroad retirement income
79 Equitable adjustments attach explanation
82 Nonresident active duty military pay
85 State tax refund distributed to beneficiary
88 Nonresident military spouse income
Amount
and/or 1099s with Utah withholding tax
Attach completed schedule to your 2013 Utah income tax return
Attach completed schedule to your 2013 Utah Income Tax return
Code Amount
Code Code
Code Code Amount
Code Code Code Amount
Continued Income Tax Supplemental Schedule Rev 12/13
Do not send TC 675Rs or Utah 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 40Ws if needed
Do not send Utah Schedule(s) K 1 with return Enter information below Use additional TC 40Ws if needed
Do not send W 2s or 1099s
Do not send your W 2s and 1099s with your return
Enter mineral production withholding from TC 675R in Part 2 of
Enter this total on form TC 40 page 2 line 33
Enter total income tax withholding from all lines 7
Enter total mineral production withholding tax from all lines 5 Enter this total on form TC 40 page 2 line 36
Enter total pass through withholding tax from all lines 3 Enter on TC 40 page 2 line 35
enter W 2 and 1099 information below but if there is Utah
First TC 675R or Utah Schedule K 1
First Utah Schedule K 1 Second Utah Schedule K 1
First W 2 or 1099 Second W 2 or 1099
from Utah Schedule K 1
IMPORTANT
Instead
Line explanations:
Line explanations:
or credited on Utah return
Part 1 Additions to Income (write the code and amount of each addition to income see insructions)
Part 2 Subtractions from Income (write the code and amount of each subtraction from income see instructions)
Part 2 Utah Mineral Production Withholding Tax TC 675R
Part 3 Apportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit see instructions)
Part 3 Utah Pass through Entity Taxpayer Withholding Utah Schedule K 1
Part 4 Nonapportionable Nonrefundable Credits (write the code and amount of each nonrefundable credit see instructions)
Part 5 Refundable Credits (write the code and amount of each refundable credit see instructions)
Rev 12/13 Income Tax Supplemental Schedule
Rev 12/13 Mineral Production and Pass through Withholding Tax
Rev 12/13 Part 1 Utah Withholding Tax Schedule
Second TC 675R or Utah Schedule K 1
Spouse's enrollment number
Submit this page ONLY if data entered
Submit this page ONLY if data entered
TC 40; enter pass through entity withholding in Part 3 of TC 40W
TC 40A
TC 40W
Third TC 675R or Utah Schedule K 1 Fourth TC 675R or Utah Schedule K 1
Third Utah Schedule K 1 Fourth Utah Schedule K 1
Third W 2 or 1099 Fourth W 2 or 1099
Total additions to income (add all additions to income and enter total here and on TC 40 line 5)
Total apportionable nonrefundable credits (add all credits and enter total here and on TC 40 line 24)
Total nonapportionable nonrefundable credits (add all Part 4 credits and enter total here and on TC 40 line 26)
Total refundable credits (add all refundable credits and enter total here and on TC 40 line 38)
Total subtractions from income (add all subtractions and enter total here and on TC 40 line 8)
Tribe
Use additional forms TC 40W Part 2 or Part 3 if needed
Use additional TC 40W forms if you have more than four W 2s
withholding on the form
Your enrollment number
Your last name
Your last name Your social security number
Your social security number