Form 1041-N
(Rev. December 2019)
Department of the Treasury
Internal Revenue Service
U.S. Income Tax Return for Electing
Alaska Native Settlement Trusts
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Go to www.irs.gov/Form1041N for instructions and the latest information.
OMB No. 1545-1776
For calendar year or short year beginning , 20 , and ending , 20 .
Part I General Information
1 Name of trust
2 Employer identification number
3a Name and title of trustee
3b Number, street, and room or suite no. (If a P.O. box, see the instructions.)
3c City or town, state, and ZIP code
4 Name of sponsoring Alaska Native Corporation
5 Was Form 1041 filed in the prior year?
Yes No
6 Check applicable boxes:
Amended return Final return Change in fiduciary’s name Change in fiduciary’s address
Part II
Tax Computation
Income
1a Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
b Tax-exempt interest. Don’t include on line 1a . . . . . . . . . . 1b
2 a Total ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . 2a
b Qualified dividends (see instructions) . . . . . . . . . . . . 2b
3 Capital gain or (loss) (Schedule D) . . . . . . . . . . . . . . . . . . . . . 3
4
Other income. List type and amount
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4
5 Total income. Combine lines 1a, 2a, 3, and 4 . . . . . . . . . . . . . . . . .
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5
Deductions
6 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Trustee fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Attorney, accountant, and return preparer fees . . . . . . . . . . . . . . . . . 8
9 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . . 9
10 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . .
10
11 Exemption (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 11
12 Total deductions. Add lines 6 through 11 . . . . . . . . . . . . . . . . . .
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12
Tax and Payments
13 Taxable income. Subtract line 12 from line 5 . . . . . . . . . . . . . . . . .
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13
14 Tax. If line 13 is a (loss), enter -0-. Otherwise, see the instructions and check the applicable
box:
Multiply line 13 by 10% (0.10) or
Schedule D . . . . . . . . . . . .
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14
15
Credits (see instructions). Specify
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15
16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . 16
17 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . .
17
18 Total tax. Add line 16 and line 17. See instructions . . . . . . . . . . . . . . . . 18
19 Current year net 965 tax liability paid from Form 965-A, Part II, column (k) (see instructions) . . 19
20 Payments. See instructions . . . . . . . . . . . . . . . . . . . . . . .
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20
21 Tax due. If line 20 is smaller than the total of lines 18 and 19, enter amount owed . . . . . 21
22 Overpayment. If line 20 is larger than the total of lines 18 and 19, enter amount overpaid . . . 22
23
Amount of line 22 to be: a Credited to next year’s estimated tax
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b Refunded
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23
Part III
Other Information
1 During the tax year, did the trust receive property or an assignment of income from an Alaska Native Corporation?
If “Yes,” see the instructions for the required attachments . . . . . . . . . . . . . . . . . . .
Yes No
2
During the year, did the trust receive a distribution from, or was it the grantor of, or the transferor to, a foreign trust?
3
At any time during the calendar year, did the trust have an interest in or a signature or other authority over a
financial account in a foreign country (such as a bank account, securities account, or other financial account)? See
the instructions for exceptions and filing requirements for FinCEN Form 114 . . . . . . . . . . . . .
If “Yes,” enter the name of the foreign country
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4
Was the trust a specified domestic entity required to file Form 8938 for the tax year? See Instructions for Form 8938 .
5 To make a section 643(e)(3) election, complete Schedule D and check here. See instructions . . . . .
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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 trustee) is based on all information of which preparer has any knowledge.
Also, under section 646(c)(2) of the Internal Revenue Code, if this is the initial Form 1041-N filed for the above-named Alaska Native Settlement Trust,
signing and filing this return will serve as the statement by the trustee electing to treat such trust as an Electing Alaska Native Settlement Trust.
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Signature of trustee or officer representing trustee
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Date
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 address
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Firm’s EIN
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Phone no.
For Paperwork Reduction Act Notice, see the Instructions for Form 1041-N.
Cat. No. 32234Q
Form 1041-N (Rev. 12-2019)