f1042s - Form 1042-S Foreign Persons U.S Source Income...

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Form 1042-S Department of the Treasury Internal Revenue Service Foreign Person’s U.S. Source Income Subject to Withholding Information about Form 1042-S and its separate instructions is at . 20 15 AMENDED PRO-RATA BASIS REPORTING OMB No. 1545-0096 Copy A for Internal Revenue Service 1 Income code 2 Gross income 3 Chap. 3: 3a Exemption code 3b Tax rate 4 Chap. 4: 4a Exemption code 4b Tax rate 5 Withholding allowance 6 Net income Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 8 Tax withheld by other agents 9 Tax paid by withholding agent 10 Total withholding credit 11 Amount repaid to recipient 12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code 12d Withholding agent's name 12e Withholding agent's Global Intermediary Identification Number (GIIN) 12f Country code 12g Foreign taxpayer identification number, if any 12h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any 13b Ch. 3 status code 13c Ch. 4 status code 13d Recipient's name 13e Recipient's country code 13f Address (number and street) 13g City or town, state or province, country, ZIP or foreign postal code 13h Recipient's GIIN 13i Recipient's foreign tax identification number, if any 14a Primary Withholding Agent's Name (if applicable) 14b Primary Withholding Agent's EIN 15a Intermediary or flow-through entity's EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code 15d Intermediary or flow-through entity's name 15e Intermediary or flow-through entity's GIIN 15f Country code 15g Foreign tax identification number, if any 15h Address (number and street) 15i City or town, state or province, country, ZIP or foreign postal code 16 Recipient's account number 17 Recipient's date of birth 18 Payer's name 19 Payer's TIN 20 Payer's GIIN 21 State income tax withheld 22 Payer’s state tax no. 23 Name of state For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11386R Form 1042-S (2015)
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Form 1042-S Department of the Treasury Internal Revenue Service Foreign Person’s U.S. Source Income Subject to Withholding Information about Form 1042-S and its separate instructions is at . 20 15 AMENDED PRO-RATA BASIS REPORTING OMB No. 1545-0096 Copy B for Recipient For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11386R Form 1042-S (2015) 1 Income code 2 Gross income 3 Chap. 3: 3a Exemption code 3b Tax rate 4 Chap. 4: 4a Exemption code 4b Tax rate 5 Withholding allowance 6 Net income Check if tax not deposited with IRS pursuant to escrow procedure 7 Federal tax withheld 8 Tax withheld by other agents 9 Tax paid by withholding agent 10 Total withholding credit 11 Amount repaid to recipient 12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code 12d Withholding agent's name 12e Withholding agent's Global Intermediary Identification Number (GIIN) 12f Country code 12g Foreign taxpayer identification number, if any 12h Address (number and street) 12i City or town, state or province, country, ZIP or foreign postal code 13a Recipient's U.S. TIN, if any
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