Form
1041
Department of the Treasury—Internal Revenue Service
U.S. Income Tax Return for Estates and Trusts
2016
OMB No. 1545-0092
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Information about Form 1041 and its separate instructions is at www.irs.gov/form1041.
For calendar year 2016 or fiscal year beginning , 2016, and ending , 20
Name of estate or trust (If a grantor type trust, see the instructions.)
Name and title of fiduciary
Number, street, and room or suite no. (If a P.O. box, see the instructions.)
City or town, state or province, country, and ZIP or foreign postal code
A Check all that apply:
Decedent’s estate
Simple trust
Complex trust
Qualified disability trust
ESBT (S portion only)
Grantor type trust
Bankruptcy estate-Ch. 7
Bankruptcy estate-Ch. 11
Pooled income fund
B Number of Schedules K-1
attached (see
instructions)
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C Employer identification number
D Date entity created
E Nonexempt charitable and split-
interest trusts, check applicable
box(es), see instructions.
Described in sec. 4947(a)(1). Check here
if not a private foundation . . .
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Described in sec. 4947(a)(2)
F
Check
applicable
boxes:
Initial return Final return Amended return
Net operating loss carryback
Change in trust's name
Change in fiduciary
Change in fiduciary's name Change in fiduciary's address
G Check here if the estate or filing trust made a section 645 election . . . . . .
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Trust TIN
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Income
1 Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2a Total ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . 2a
b
Qualified dividends allocable to:
(1)
Beneficiaries
(2) Estate or trust
3 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) . . . . . . . . . 3
4 Capital gain or (loss). Attach Schedule D (Form 1041) . . . . . . . . . . . . . . 4
5 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) . 5
6 Farm income or (loss). Attach Schedule F (Form 1040) . . . . . . . . . . . . . . 6
7 Ordinary gain or (loss). Attach Form 4797 . . . . . . . . . . . . . . . . . . 7
8 Other income. List type and amount 8
9 Total income. Combine lines 1, 2a, and 3 through 8 . . . . . . . . . . . . .
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9
Deductions
10 Interest. Check if Form 4952 is attached
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10
11 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Fiduciary fees . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Charitable deduction (from Schedule A, line 7) . . . . . . . . . . . . . . . . 13
14 Attorney, accountant, and return preparer fees . . . . . . . . . . . . . . . . 14
15 a Other deductions not subject to the 2% floor (attach schedule) . . . . . . . . . . . 15a
b Net operating loss deduction. See instructions . . . . . . . . . . . . . . . . 15b
c Allowable miscellaneous itemized deductions subject to the 2% floor . . . . . . . . . 15c
16 Add lines 10 through 15c . . . . . . . . . . . . . . . . . . . . . .
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16
17 Adjusted total income or (loss). Subtract line 16 from line 9 . . . 17
18 Income distribution deduction (from Schedule B, line 15). Attach Schedules K-1 (Form 1041) 18
19 Estate tax deduction including certain generation-skipping taxes (attach computation) . . . 19
20 Exemption . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 18 through 20 . . . . . . . . . . . . . . . . . . . . . . .
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21
Tax and Payments
22 Taxable income. Subtract line 21 from line 17. If a loss, see instructions . . . . . . . . 22
23 Total tax (from Schedule G, line 7) . . . . . . . . . . . . . . . . . . . . 23
24 Payments: a 2016 estimated tax payments and amount applied from 2015 return . . . .
24a
b Estimated tax payments allocated to beneficiaries (from Form 1041-T) . . . . . . . . 24b
c Subtract line 24b from line 24a . . . . . . . . . . . . . . . . . . . . .
24c
d Tax paid with Form 7004. See instructions . . . . . . . . . . . . . . . . . .
24d
e Federal income tax withheld. If any is from Form(s) 1099, check
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24e
Other payments: f Form 2439 ; g Form 4136
; Total
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24h
25 Total payments. Add lines 24c through 24e, and 24h . . . . . . . . . . . . .
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25
26 Estimated tax penalty. See instructions . . . . . . . . . . . . . . . . . . .
26
27 Tax due. If line 25 is smaller than the total of lines 23 and 26, enter amount owed . . . . .
27
28 Overpayment. If line 25 is larger than the total of lines 23 and 26, enter amount overpaid . .
28
29 Amount of line 28 to be: a Credited to 2017 estimated tax
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; b Refunded
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29
Sign
Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
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Signature of fiduciary or officer representing fiduciary
Date
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EIN of fiduciary if a financial institution
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes No
Paid
Preparer
Use Only
Print/Type preparer's name
Preparer's signature Date
Check if
self-employed
PTIN
Firm's name
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Firm's EIN
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Firm's address
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Phone no.
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11370H
Form
1041 (2016)