Form    1041-N                                                       U.S. Income Tax Return for Electing 
(Rev. December 2019)                                                   Alaska Native Settlement Trusts                                                     OMB No. 1545-1776
Department of the Treasury                                  ▶ Go to www.irs.gov/Form1041N for instructions and the latest information.
Internal Revenue Service 
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                                                                                                         4    Name of sponsoring Alaska Native Corporation 

3b    Number, street, and room or suite no. (If a P.O. box, see the instructions.) 

3c    City or town, state, and ZIP code                                                                                                 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 
                                   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 
                 Income            3   Capital gain or (loss) (Schedule D)   . .   . .           . . . .  . .    . . .    . .       . . . .  .   .       3 
                                   4   Other income. List type and amount ▶                                                                              4 
                                   5   Total income. Combine lines 1a, 2a, 3, and 4  .           . . . .  . .    . . .    . .       . . . .  .  ▶        5 
                                   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 
                 Deductions        11  Exemption (see instructions)  .   .   . .   . .           . . . .  . .    . . .    . .       . . . .  .   .       11 
                                   12  Total deductions. Add lines 6 through 11  .   .           . . . .  . .    . . .    . .       . . . .  .  ▶        12 
                                   13  Taxable income. Subtract line 12 from line 5 .            . . . .  . .    . . .    . .       . . . .  .  ▶        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 .         . .    . . .    . .       . . . .    ▶         14 
                                   15  Credits (see instructions). Specify ▶                                                                             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 .    . .   . .   . .           . . . .  . .    . . .    . .       . . . .  .  ▶        20
                 Tax and Payments  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 ▶                         b  Refunded ▶        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?                     Yes  No 
                                   If “Yes,” see the instructions for the required attachments  .      .  . .    . . .    . .       . . . .  .   .     . .    .   .
   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 ▶
   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  .             .   .     . .  ▶
                                       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. 
Sign                                   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. 
Here                                   ▲                                                                         ▲
                                                                                                                                                       May  the  IRS  discuss  this  return  
                                                                                                                                                       with the preparer shown below?    
                                            Signature of trustee or officer representing trustee                     Date                              See instr.        Yes                 No
                                       Print/Type preparer’s name               Preparer’s signature                        Date                              PTIN
Paid                                                                                                                                         Check         if 
                                                                                                                                             self-employed
Preparer 
Use Only                               Firm’s name      ▶                                                                               Firm’s EIN  ▶
                                       Firm’s address  ▶                                                                                Phone no.
For Paperwork Reduction Act Notice, see the Instructions for Form 1041-N.                                            Cat. No. 32234Q                Form 1041-N (Rev. 12-2019) 

Form 1041-N (Rev. 12-2019)                                                                                                                      Page  2 
Schedule D     Capital Gains and Losses 
Part I—Short-Term Capital Gains and Losses—Assets Held One Year or Less 

           (a) Description of property              (b) Date        (c) Date sold     (d) Sales price   (e) Cost or other basis  (f) Gain or (loss) 
           (Example, 100 shares 7%                  acquired        (mo., day, yr.)                         (see instructions)   for the entire year 
           preferred of “Z” Co.)                  (mo., day, yr.)                                                                (col. (d) less col. (e))   

1 

2  Short-term capital gain or (loss) from other forms or schedules  .     .  .      . .   . .   . .     .   . .  .        2 

3  Short-term capital loss carryover  .     . . . . .   .    .    . .   . .  .      . .   . .   . .     . .   .  .        3      (                          )

4  Net short-term capital gain or (loss). Combine lines 1 through 3 in column (f)  .        .   . .     .   . .  .        4 
Part II—Long-Term Capital Gains and Losses—Assets Held More Than One Year 

           (a) Description of property              (b) Date        (c) Date sold     (d) Sales price   (e) Cost or other basis  (f) Gain or (loss) 
           (Example, 100 shares 7%                  acquired        (mo., day, yr.)                         (see instructions)   for the entire year 
           preferred of “Z” Co.)                  (mo., day, yr.)                                                                (col. (d) less col. (e))   

5 

6  Long-term capital gain or (loss) from other forms or schedules  .      .  .      . .   . .   . .     .   . .  .        6 

7  Capital gain distributions .  .      . . . . . . .   .    .    . .   . .  .      . .   . .   . .     . .   .  .        7 

8  Enter gain, if applicable, from Form 4797  .   . .   .    .    . .   . .  .      . .   . .   . .     .   . .  .        8 

9  Long-term capital loss carryover  .      . . . . .   .    .    . .   . .  .      . .   . .   . .     . .   .  .        9      (                          )

10 Net long-term capital gain or (loss). Combine lines 5 through 9 in column (f)  .         .   . .     .   . .  .        10 
                                                                                                                    Form 1041-N (Rev. 12-2019) 

Form 1041-N (Rev. 12-2019)                                                                                                Page  3 
Part III—Summary of Parts I and II 
11    Combine lines 4 and 10 and enter the result. If a loss, go to line 12. If a gain, also enter the gain
      on page 1, line 3, and complete page 1 through line 13 .     . . .   . . . . . .  .          . . .   . .   11 
Next: Skip line 12 (below) and complete    Part IV (below) if line 13 on page 1 is greater than zero and:    a)
line 2b on page 1 is greater than zero; or b) Schedule D, lines 10 and 11, are both greater than zero. 

12    If line 11 is a loss, enter here and on page 1, line 3, the  smaller of the loss on line 11 or ($3,000). 
      Then complete page 1 through line 13  .      .   . . . .     . . .   . . . . . .  .          . . .   . .   12 (                          )
Next: If the loss on line 11 is more than ($3,000), or if page 1, line 13, is less than zero, skip Part IV below 
and complete the Capital Loss Carryover Worksheet in the instructions before completing the rest of Form
1041-N. Otherwise, skip Part IV below and complete the rest of Form 1041-N. 
Part IV—Tax Computation Using Maximum Capital Gains Rates 

13    Enter the taxable income from page 1, line 13  .   . . .     . . .   . . . . . .  .          . . .   . .   13 

14    Enter the qualified dividends from page 1, line 2b   . .     . . .   . . . .   14 

15    Enter the amount from Form 4952, line 4g  .      . . .       15 

16    Enter the amount from Form 4952, line 4e  .      . . .       16 

17    Subtract line 16 from line 15. If zero or less, enter -0-  . . . .   . . . .   17 

18    Subtract line 17 from line 14. If zero or less, enter -0-  . . . .   . . . .   18 

19    Enter the smaller of line 10 or line 11   .  .   . . .       19 

20    Enter the smaller of line 15 or line 16   .  .   . . .       20 

21    Subtract line 20 from line 19. If zero or less, enter -0-  . . . .   . . . .   21 

22    Add lines 18 and 21  .     . . .     .  . .  .   . . . .     . . .   . . . .   22 

23    Add line 18 from the Unrecaptured Section 1250 Gain 
      Worksheet  and  line  7  from  the  28%  Rate  Gain 
      Worksheet and enter the amount here  .       .   . . .       23 
24    Enter the smaller of line 21 or line 23   .  .   . . . .     . . .   . . . .   24 

25    Subtract line 24 from line 22  .     .  . .  .   . . . .     . . .   . . . .   25 

26    Enter the smaller of line 13 or line 25   .  .   . . . .     . . .   . . . . . .  .          . . .   . .   26 

27    Subtract line 26 from line 13  .     .  . .  .   . . . .     . . .   . . . . . .  .          . . .   . .   27 

28    Multiply line 27 by 10% (0.10). Enter here and on page 1, line 14. Also check the Schedule D box on
      that line  . .       . . . . . .     .  . .  .   . . . .     . . .   . . . . . .  .          . . .   . .   28 
                                                                                                               Form 1041-N (Rev. 12-2019) 

Form 1041-N (Rev. 12-2019)                                                                                                              Page  4 
Schedule K Distributions to Beneficiaries                                                                         Page  of 
(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

(a)  Beneficiary’s name, street address, city, state, and ZIP code (b)  Beneficiary’s SSN                    (g)  Total distributions   
                                                                                                             (Add amounts in (c) through (f)) 

(c)  Tier I distributions  (d)  Tier II distributions (e)  Tier III distributions (f)  Tier IV distributions 

                                                                                                             Form 1041-N (Rev. 12-2019)