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                         PASSTHROUGH ENTITY WITHHOLDING -
                         NONRESIDENT MEMBER ADJUSTMENT
                         OFFICE OF STATE TAX COMMISSIONER                                          Form PWA
                         SFN 28728 (8-2021)
                                                                                                   2021
 Part 1 - To be completed by nonresident member
 Nonresident Member Name                                                                       Social Security Number (or FEIN)

 1. Estimated North Dakota distributive share of income or estimated total North Dakota taxable
    income, whichever is smaller                                                                   1
 2. Multiply line 1 by 2.90% (.029)                                                                2
 3. a.  Estimated North Dakota income tax paid                                      3a
    b.  Additional North Dakota income tax withheld from wage income                3b
 4. Withholding adjustment amount. Add lines 3a and 3b                                             4
 5. Amount to withhold. Subtract line 4 from line 2                                                5
 I declare, under penalty of perjury, that this form is correct and complete to the best of my knowledge and belief.
 Nonresident Member's Signature                                                            Date

 Part 2 - To be completed by passthrough entity
 Passthrough Entity Name                                                                       Federal Employer Identification Number

 Tax year for which this adjustment applies. If the passthrough entity and the nonresident member have different tax years, specify
 the tax year of the passthrough entity to which the adjustment applies.
       Calendar year 2021 OR          Fiscal year beginning                   2021, and ending                      ,

                                            A “nonresident member” means an 
Purpose of form                             individual who is not domiciled in North      Specific instructions for 
Under North Dakota Century Code             Dakota, a trust that is not organized in      passthrough entity
(N.D.C.C.) § 57-38-31.1, a passthrough      North Dakota, or a passthrough entity that 
entity is required to withhold North Dakota does not have a commercial domicile in        If you receive Form PWA from a 
income tax at the rate of 2.90% from        North Dakota.                                 nonresident member, do the following:
a nonresident member’s North Dakota         A “passthrough entity” means a                1.  Complete Part 2.
distributive share of income if (1) it is   partnership (all types), S corporation, 
$1,000 or more and (2) it is not included   trust, limited liability company not taxed as 2.  Only withhold the amount shown in 
in a composite return. If eligible, a       a C corporation, or other entity not taxed     Part 1, line 5, from the nonresident 
nonresident member may request that an      at the entity level for North Dakota income    member’s North Dakota distributive 
amount less than the statutory amount       tax purposes.                                  share of income for the specified tax 
                                                                                           year.
be withheld by completing and submitting    Exemption for certain members. If 
Form PWA to the passthrough entity.         the nonresident member is a passthrough       3.  Fill in the circle under “Form PWA or 
                                            entity, the member may be eligible to elect    Form PWE” for the nonresident member 
General instructions                        to exempt its North Dakota distributive        on your North Dakota income tax 
                                            share of income from North Dakota income       return as follows—
A nonresident member is eligible to use     tax withholding. See Form PWE for more           If filing Form 38 (fiduciary return), 
Form PWA if any of the following apply:     information.                                       see Schedule BI, Column 6.
  The member already paid estimated                                                         If filing Form 58 (partnership return), 
 North Dakota income tax on the North                                                          see Schedule KP, Column 7.
 Dakota distributive share of income.       Specific instructions for                        If filing Form 60 (S corporation 
                                            nonresident member                                 return), see Schedule KS, Column 7.
  The member had additional North Dakota   Complete Part 1 of Form PWA. On line 3,       4.  Attach a copy of Form PWA to your 
 income tax withheld from wage income       the North Dakota income tax paid or            North Dakota income tax return. 
 to cover the tax expected to be owed on    withheld must be for the same tax year         Keep the original signed copy for your 
 the North Dakota distributive share of     that your North Dakota distributive share      records.
 income.                                    of income is reportable on your North 
  The member will have a North Dakota      Dakota income tax return. Submit the          Privacy Act Notification. In compliance 
 taxable income less than the North         completed Form PWA to the passthrough         with the Privacy Act of 1974, disclosure of a 
 Dakota distributive share of income        entity before the last day of the             social security number or Federal Employer 
 because of an offsetting North Dakota      passthrough entity’s tax year to which the    Identification Number (FEIN) on this form is 
                                                                                          required under N.D.C.C. §§ 57-01-15 and 
 loss or adjustment to income on the        adjustment it is to apply.                    57-38-31.1, and will be used for tax reporting, 
 member’s North Dakota income tax                                                         identification, and administration of North Dakota 
 return.                                                                                  tax laws. Disclosure is mandatory. Failure to 
                                                                                          provide the social security number or FEIN may 
                                                                                          delay or prevent the processing of this form.






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