State of Rhode Island Division of Taxation 
     2023 RI Schedule PTW - 1041 
     Pass-through Withholding Transmittal Schedule                                                                  23106399990101

Name                                                                                                                         Federal employer identification number

   Cannot distribute due to Federal or                Income is exempt from tax                                              Members with less than $1,000 in RI 
   State restrictions (see instructions)                                                                                     source income (see instructions)
   All nonresident income reported on Form RI-1040C - A PTE election was made for all individual members 
   Composite Income Tax Return                        and Form RI-PTE was filed for the taxable year.

Part A - Nonresident Rhode Island Source Income Calculation

1  Income distribution deduction from Federal Form 1041, line 18..................................................................................        1

2  Rhode Island source income included in the amount on line 1........................................................................................... 2
 
3  Nonresident portion of Rhode Island source income included in the amount on line 2...............................................                      3

                                                                                                                    Column A                                  Column B
Part B - Pass-through Withholding Calculation                                                                                                               Sub S Corps, Individuals,  
                                                                                                                    C Corporations only                   LLCs, Partnerships & Trusts
4  Rhode Island source income of nonresident members by entity type .....................                       4a                                        4b
5  Rhode Island source income of nonresident members that cannot be distributed                                 5a                                        5b
   to Federal or State restrictions ............................................................................
6  Rhode Island source income of nonresident members exempt from tax.................                           6a                                        6b

7  Rhode Island source income of those nonresident members with income of less                                  7a                                        7b
   than $1,000 net of modifications (attach schedule).................................................
8  Rhode Island source income of nonresident reported on Form RI-1040C ..............                           8a                                        8b

9  Rhode Island source income of nonresident members reported on Form RI-PTE ..                                 9a                                        9b
10                                       DRAFT10a                                                                                                         10b
   Rhode Island source income of nonresident members subject to PT withholding 
   (For Column A, subtract 5a - 9a from 4a; For Column B, subtract 5b - 9b from 4b)
11 Rhode Island nonresident pass-through withholding rate........................................               11a 7.0%                                  11b 5.99%

12 Rhode Island pass-through withholding. For each col. multiply line 10 by line 11 ...                         12a                                       12b

13 TOTAL Rhode Island pass-through withholding due.  Add lines 12a and 12b.  Enter here and on Form RI-1041, line 14d                                     13

                                         09/26/2023

                                                                                                                                                                      New 
                                                                                                                                                                      08/2023

     State of Rhode Island Division of Taxation 
     2023 RI Schedule PTW - 1041 
     Pass-through Withholding Transmittal Schedule 23106399990102

Name                                                                                                             Federal employer identification number

Part C - Pass-through Withholding Paid on Entity’s Behalf by Another Pass-through Entity
     Name                                       Federal Employer Identification Number                           Pass-through Withholding Amount

14 a

b

c

d

e

f

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h

i

j

k

l

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          DRAFT 
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s         09/26/2023

t

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v Total Pass-through withholding (add amounts from lines 14a thru 14u). Enter here and on Form RI-1041, line 15d.