Free TC-941R, Utah Annual Withholding Reconciliation - Utah

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94182
Utah State Tax Commission

Utah Annual Withholding Reconciliation
Check here to close Utah Account ID your account
Federal EIN Tax Period Due Date (mmddyyyy)

TC-941R
Rev. 3/09

9998
Name and address

Check if AMENDED 1. Total number of W-2s and 1099s, or TC-675Rs issued 2. Total Utah wages, compensation, and distributions reported on W-2s and 1099s, or TC-675Rs 3. Total federal income tax withheld on W-2s and 1099s 4. Total Utah income tax withheld on W-2s and 1099s, or TC-675Rs 5. Utah tax withheld as reported on TC-941 return(s) Jan - Mar Apr - Jun
5a 5b 1 2 3 4

(replacement, not net difference)

00 00 00 00 00
6 7 annual filers use 5d only

00 00

Jul - Sep Oct - Dec

5c 5d

6. Add lines 5a through 5d and enter the total here 7. Subtract line 6 from line 4 and enter amount here (see instructions)
How did you file your W-2s How did you file your TC-675Rs
Signature X

00 00

Paper Paper

Electronically Electronically

How did you file your 1099s Electronically Paper If you check paper on any, include them with this reconciliation
Date Phone no.

Under penalties provided by law, I declare, to the best of my knowledge, this return is true and correct.

USTC use only (box no.)

_________________
USTC use only

Return ENTIRE form, coupon and payment to the Utah State Tax Commission

TC-941RPC Rev. 3/09

Payment Coupon for Utah Withholding Reconciliation, TC-941RPC
Utah Account ID Payment Period Ending (mm/dd/yyyy) Payment Due Date (mm/dd/yyyy)

Tax Type

Account name: _______________________________________________ Amount Paid Do not send cash. Do not staple check to this coupon. Detach any check stub.

W T R

UTAH STATE TAX COMMISSION 210 N 1950 W SLC UT 84134-0600

TC-941R Rev. 3/09

90000
Annual Reconciliation, TC-941R You must file a reconciliation annually to balance your returns (forms TC941) with withholding tax paid. You may file electronically at withholding.utah.gov. Employers with 250 or more W-2 forms must file electronically. See instructions in Pub 32, Online Filing and Paying of Withholding and Mineral Production Forms. Other employers may file paper copies, but are encouraged to file electronically. If you file on paper, include copies of all W-2, TC-675R and 1099 forms with Utah withholding. Each form must show: Amounts paid and withheld Federal identification number (EIN) Utah withholding account number. File your annual reconciliation and withholding documents by March 31 if filing electronically (February 28 if filing on paper). Line Instructions: Line 1 Enter the total number of W-2s and 1099s or TC-675Rs you issued for the year. Line 2 Enter the total of all wages, compensation and distributions paid to employees or payments made to working interests, royalty interests, and overriding royalty owners during the year. Line 3 Enter the total amount of federal tax withheld during the year on W-2s and 1099s. Line 4 Enter the total amount of Utah tax shown on W-2s and 1099s or TC-675Rs for the year. Lines 5a-5d Enter amounts from each quarterly return (TC-941, line 3) submitted for the year. If you file annually, report your annual amount on line 5d. Line 6 Enter the total of lines 5a-5d. Line 7 Subtract line 6 from line 4. If line 6 is less than line 4, you under reported one or more periods. Check your records and pay the difference from this line electronically or use the attached coupon, TC-941RPC. If line 6 is more than line 4, you over reported one or more periods. Check your records. If you have overpaid, request a refund in writing. You may be charged a penalty of $50 per form (up to $1,000) if you do not file the TC-941R with accompanying W-2, TC-675R, or 1099 forms. Other penalties may also apply if the Utah withholding account number is not shown on each form, or if your form is incomplete. Amended Reconciliation, TC-941R If you must change a previously filed annual reconciliation, go to withholding.utah.gov or complete a TC-941R showing corrected amounts. Include all corrected W-2, TC-675R and 1099 forms. If you owe additional tax, pay that amount plus interest from the original due date to the date amended using a payment coupon (TC-941RPC). Unpaid balances will result in additional penalties and interest. See Pub 58, Utah Interest and Penalties. If you overpaid, you must amend the TC-941 for the period of overpayment and mail it to the Tax Commission with a letter explaining the amendment reason and stating if you want the refund sent to you or credited to a future period. Mailing the Annual Reconciliation To avoid delays, mail your annual reconciliation (with any needed reconciliation payment) and withholding documents separately from your TC-941 and payment.

Mail to: Utah State Tax Commission 210 N 1950 W Salt Lake City, UT 84134-0600 For additional information see Pub 14, Utah Withholding Tax Guide. To make changes to your account, use form TC-69C, Notice of Change for A Tax Account available at tax.utah.gov/forms or by calling 801-297-6700 or 1-800662-4335 ext. 6700.