Fillable Form 1042 2019 Annual Withholding Tax Return

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Form 1042 2019 Annual Withholding Tax Return

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Form 1042
Department of the Treasury
Internal Revenue Service
Annual Withholding Tax Return for U.S. Source
Income of Foreign Persons
▶
Go to www.irs.gov/Form1042 for instructions and the latest information.
OMB No. 1545-0096
2019
If this is an amended return, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
▶
Name of withholding agent Employer identification number
Ch. 3 Status Code Ch. 4 Status Code
Number, street, and room or suite no. (if a P.O. box, see instructions)
City or town, state or province, country, and ZIP or foreign postal code
For IRS Use Only
CC
RD
CAF
CR
EDC
FD
FF
FP
I
SIC
If you do not expect to file this return in the future, check here
▶
Enter date final income paid
▶
Section 1 Record of Federal Tax Liability (Do not show federal tax deposits here)
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Line
No.
Period
ending
Tax liability for period
(including any taxes assumed
on Form(s) 1000)
1
7
2
15
3
22
4
31
5 Jan. total
6
7
7
15
8
22
9
28
10 Feb. total
11
7
12
15
13
22
14
31
15 Mar. total
16
7
17
15
18
22
19
30
20 Apr. total
Line
No.
Period
ending
Tax liability for period
(including any taxes assumed
on Form(s) 1000)
21
7
22
15
23
22
24
31
25 May total
26
7
27
15
28
22
29
30
30 June total
31
7
32
15
33
22
34
31
35 July total
36
7
37
15
38
22
39
31
40 Aug. total
Line
No.
Period
ending
Tax liability for period
(including any taxes assumed
on Form(s) 1000)
41
7
42
15
43
22
44
30
45 Sept. total
46
7
47
15
48
22
49
31
50 Oct. total
51
7
52
15
53
22
54
30
55 Nov. total
56
7
57
15
58
22
59
31
60 Dec. total
61 No. of Forms 1042-S filed: a On paper b Electronically
62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . . 62a
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
62b(1)
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
62b(2)
c Total gross amounts reported (Add lines 62a–b) . . . . . . . . . . . . . . . . . 62c
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . . 62d
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following.
No
Designee’s
name
▶
Phone
no.
▶
Personal identification
number (PIN)
▶
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 withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
▲
Date
Capacity in which acting
▶
Daytime phone number
▶
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
▶
Firm’s address
▶
Firm’s EIN
▶
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 11384V
Form 1042 (2019)
Form 1042 (2019)
Page 2
63 Total tax reported as withheld or paid by withholding agent on all Forms 1042-S and 1000:
a Tax withheld by withholding agent . . . . . . . . . . . . . . . . . . . . . . 63a
b Tax withheld by other withholding agents:
(1) For payments other than substitute dividends . . . . . . . . . . . . . . . . . .
63b(1)
(2) For substitute dividends . . . . . . . . . . . . . . . . . . . . . . . . .
63b(2)
c Adjustments to withholding:
(1) Adjustments to overwithholding . . . . . . . . . . . . . . . . . . . . . .
63c(1)
( )
(2) Adjustments to underwithholding . . . . . . . . . . . . . . . . . . . . . .
63c(2)
d 63d
e
Tax paid by withholding agent . . . . . . . . . . . . . . . . . . . . . . . .
63e
Total tax reported as withheld or paid (Add lines 63a–d) . . . . . . . . . . . . . . .
64 Total net tax liability
a Adjustments to total net tax liability . . . . . . . . . . . . . . . . . . . . . . 64a
b Total net tax liability under chapter 3 . . . . . . . . . . . . . . . . . . . . . . 64b
c Total net tax liability under chapter 4 . . . . . . . . . . . . . . . . . . . . . . 64c
d Excise tax on specified federal procurement payments (Total payments made x 2% (0.02)) . . . . 64d
e Total net tax liability (Add lines 64a–d) . . . . . . . . . . . . . . . . . . . . .
64e
65 Total paid by electronic funds transfer (or with a request for extension of time to file):
a Total paid during calendar year . . . . . . . . . . . . . . . . . . . . . . . . 65a
b Total paid during subsequent year . . . . . . . . . . . . . . . . . . . . . . . 65b
66 Enter overpayment applied as credit from 2018 Form 1042 . . . . . . . . . . . . . . 66
67 Credit for amounts withheld by other withholding agents:
a For payments other than substitute dividend payments . . . . . . . . . . . . . . . . 67a
b For substitute dividend payments . . . . . . . . . . . . . . . . . . . . . . . 67b
68 Total payments. Add lines 65 through 67 . . . . . . . . . . . . . . . . . . . . 68
69 If line 64e is larger than line 68, enter balance due here . . . . . . . . . . . . . . . . 69
70a Enter overpayment attributable to overwithholding on U.S. source income of foreign persons . . . 70a
b Enter overpayment attributable to excise tax on specified federal procurement payments . . . . 70b
71 Apply overpayment (sum of lines 70a and 70b) to (check one):
Credit on 2020 Form 1042 or Refund
Section 2 Reconciliation of Payments of U.S. Source FDAP Income
1 Total U.S. source FDAP income required to be withheld upon under chapter 4 . . . . . . . . 1
2 Total U.S. source FDAP income required to be reported under chapter 4 but not required to be
withheld upon under chapter 4 because:
a Amount of income paid to recipients whose chapter 4 status established no withholding is required . 2a
b Amount of excluded nonfinancial payments. . . . . . . . . . . . . . . . . . . . 2b
c Amount of income paid with respect to grandfathered obligations . . . . . . . . . . . . 2c
d Amount of income effectively connected with the conduct of a trade or business in the U.S. . . . 2d
e Total U.S. source FDAP income required to be reported under chapter 4 but not required to be
withheld upon under chapter 4 (Add lines 2a–d) . . . . . . . . . . . . . . . . . . 2e
3 Total U.S. source FDAP income reportable under chapter 4 (Add lines 1 and 2e) . . . . . . . 3
4 Total U.S. source FDAP income reported on all Forms 1042-S (from line 62a, (b)(1), and (b)(2)) . . . 4
5 Total variance, subtract line 3 from line 4, if amount other than zero, provide explanation on line 6 . . 5
6
Section 3
Potential Section 871(m) Transactions
Check here if any payments (including gross proceeds) were made by the withholding agent under a potential section 871(m)
transaction, including a notional principal contract or other derivatives contract that references (in whole or in part) a U.S. stock or
other underlying security. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section 4 Dividend Equivalent Payments by a Qualified Derivatives Dealer (QDD)
Check here if any payments were made by a QDD . . . . . . . . . . . . . . . . . . . . . . . . . . .
If box is checked, you must:
(1) Attach Schedule Q (Form 1042). See instructions.
(2) Enter the EIN (not the QI-EIN) of the QDD
▶
Form 1042 (2019)
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Form 1042 2019 Annual Withholding Tax Return

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Completed 13 May 2020

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