Form TC-41N Fillable Schedule N Pass-through Entity Withholding Tax
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(enter X in column B and 0 in column G) (not less than zero) this fiduciary Enter "1" to request a waiver for ALL beneficiaries (enter "X" in column B and "0" in column G for all beneficiaries) Enter "2" to request a waiver for SOME beneficiaries (enter "X" in column B and "0" in column F for those beneficiaries requested) (1) A) (2) A) (3) A) (4) A) (5) A) (6) A) (7) A) (Employer Identification Number) (text) (undefined) 41410 A Name of beneficiary F Income (loss) G 5% of income H Mineral production J Withholding tax An estate or trust with nonresident individual beneficiaries resident business beneficiaries and/or nonresident business beneficiaries must complete B Withholding waiver for this beneficiary attributable to Utah F times 5% ( 05) withholding credit to be paid by C X if Dependent Beneficiary I Upper tier pass (G less H and I D SSN or EIN of Beneficiary E Beneficiary s % of income through withholding not less than 0) EIN or SSN Estate/trust name Report the beneficiary s pass through withholding Total Utah withholding tax to be paid by this fiduciary: Schedule N Pass through Entity Withholding Tax TC 41N See Schedule N instructions for liability responsibilities when requesting a waiver tax from column J on Schedule K 1 line 15 Enter on TC 41 line 31 and on Sch K line 15 the information below to report the Utah income and to calculate the Utah withholding tax for these beneficiaries WITHHOLDING WAIVER REQUEST under 59 10 1403 2(5):