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                                                                               Utah State Tax Commission                                         2022
41201                                                               Utah Fiduciary Income Tax Return
                                                                                                                                                 TC-41
9998
                                                                           For calendar year 2022 or fiscal year ending (mm/yy) /
USSTC ORIGINAL FORM
                                                             Amended Return - enter code (1-5)  •              “X” if federal form 8886 filed  •
    Name of estate or trust 
                                                                                                     EIN or SSN
    Name of fiduciary 

    Fiduciary address                                                                                “X” if this is an SSN:

    City                                                           State    Zip + 4                Foreign country (if not U.S.)

1  Type of return - enter code                                                                 2  Status code                   3 “X” if this estate or trust
     A = Bankruptcy estate Ch. 7      E = Decedent’s estate              S = Simple trust                                           has any
•    B = Bankruptcy estate Ch. 11     F = Qualified funeral trust (QFT)  T = ESBT                 R = Resident    •                 nonresident    •
     C = Complex trust                G = Grantor type trust                                      N = Nonresident                   beneficiaries
     D = Qualified disability trust   H = Charitable trust                                        P = Part-year resident

4 Federal total income from federal form 1041 line 9 or 1041-QFT line 5                                                 •  4                         .00

5  Additions to income from TC-41A, Part 1 (only include amounts taxed at the trust level)                              •  5                         .00

6  Total adjusted income - add line 4 and line 5                                                                          6                          .00

7  Fiduciary fees for administering estate or trust and deducted on federal return (1041, line 12)                      •  7                         .00

8  Income distribution deduction (1041, line 18)                                                                        •  8                         .00

9  Estate tax deduction, including certain generation-skipping transfer taxes (1041, line 19)                           •  9                         .00

10  Exemption (1041, line 21)                                                                                           •  10                        .00

11  State tax refund included in federal total income                                                                   •  11                        .00

12  Subtractions from income from TC-41A, Part 2. Only include amounts that apply to income taxed at trust level.       •  12                        .00

13  Total deductions - add lines 7 through 12                                                                             13                         .00

14  Utah taxable income/loss - subtract line 13 from line 6                                                             •  14                        .00

15  Utah tax - multiply line 14 by 4.85% (.0485) (not less than zero)                                                   •  15                        .00

16  Allowable deductions for estate or trust credit (from worksheet)                      • 16                      .00

17  Initial credit before phase-out - multiply line 16 by 6% (.06)                        • 17                      .00

18  Base phase-out amount                                                                   18     12000

19  Income subject to phase-out - subtract line 18 from line 14 (not less than zero)        19                      .00

20  Phase-out amount - multiply line 19 by 1.3% (.013)                                    • 20                      .00

21  Estate or trust tax credit - subtract line 20 from line 17 (not less than zero)                                     •  21                        .00

22 Utah income tax - subtract line 21 from line 15 (not less than zero)                                                   22                         .00
     Enter amount from line 22 on page 2, line 23

              Utah Fiduciary Income Tax Return (continued)                                                                 TC-41             Pg. 2
41202         EIN or SSN                                 Estate/trust name                                                 2022
USTC ORIGINAL FORM
  23  Enter tax from line 22                                                                                         •  23                           .00

  24  Apportionable nonrefundable credits from TC-41A, Part 3 (attach TC-41A, page 1)                                •  24                           .00

  25  Subtract line 24 from line 23 (not less than zero)                                                               25                            .00
      Non or Part-year resident estate or trust - complete TC-41B before continuing on line 26

  26  Full-year resident estate or trust - enter tax from line 25 above                                              •  26                           .00
    Non or part-year resident estate or trust - enter tax from TC-41B, line 21
    Bankruptcy estate, see instructions and complete TC-41C

  27  Nonapportionable nonrefundable credits from TC-41A, Part 4 (attach TC-41A, page 1)                             •  27                           .00

  28  Subtract line 27 from line 26 (not less than zero)                                                               28                            .00

  29  AMENDED RETURN ONLY - previous refund                                                                          •  29                           .00

  30  Utah use tax                                                                                                   •  30                           .00

  31  Total pass-through withholding tax - enter the total amount from Schedule N, column J                          •  31                           .00
      Note: This amount must be paid by the due date of the return, without extensions

 32 Total tax, additions and use tax - add lines 28 through 31                                                         32                            .00

  33  Utah tax withheld shown on TC-41W, Part 1 (attach TC-41W, page 1)                                              •  33                           .00

  34  Credit for Utah fiduciary tax prepaid from TC-548 and 2021 refund applied to 2022                              •  34                           .00

  35  AMENDED RETURN ONLY - previous payments                                                                        •  35                           .00

  36  Refundable credits from TC-41A, Part 5 (attach TC-41A, page 2)                                                 •  36                           .00

  37  Total withholding and refundable credits - add lines 33 through 36                                               37                            .00

 38 TAX DUE - subtract line 37 from line 32 (not less than zero)                                                     •  38                           .00

  39  Penalty and interest (see instructions)                                       39                            .00

 40 PAY THIS AMOUNT - add line 38 and line 39                                                                        •  40                           .00

 41 REFUND - subtract line 32 from line 37 (not less than zero)                                                      •  41                           .00

  42  Enter the amount of refund from line 41 you want applied to your 2023 fiduciary tax                            •  42                           .00

                                                                                                                           USTC USE ONLY

Under penalties of perjury, I declare to the best of my knowledge and belief,
this return and accompanying schedules are true, correct and complete.
SIGN  Signature of fiduciary or officer representing estate or trust         Date         •  EIN/SSN of fiduciary    “X” if USTC may discuss 
HERE                                                                                                                 this return with preparer below:
              Preparer’s signature                                           Date         Preparer’s telephone number   Preparer’s PTIN
      Paid                                                                                                           •
  Preparer’s  Firm’s name and address                                                                               Preparer’s EIN
    Section                                                                                                          •

            Fiduciary Supplemental Schedule                                                                                 TC-41A Pg. 1
41203       EIN or SSN                                    Estate/trust name                                                 2022
USTC ORIGINAL FORM
Part 1 - Additions to Income (enter the code and amount of each addition to income)                                   Code  Amount
See instructions for codes.                                                                                         •              .00
  
                                                                                                                    •              .00

                                                                                                                    •              .00

                                                                                                                    •              .00

      Total additions to income(add all additions to income and enter total here and on TC-41, line 5)                             .00

Part 2 - Subtractions from Income (enter the code and amount of each subtraction from income)                        Code   Amount
  See instructions for codes.                                                                                       •              .00

      If using subtraction 77 (Native American Income), enter your enrollment                                       •              .00
      number and tribal code:    Tribe  
          Enrollment Number      Code                                                                               •              .00
         •  
                                                                                                                    •              .00
  
      Total subtractions from income (add all subtractions from income and enter total here and on TC-41, line 12)                 .00

Part 3 - Apportionable Nonrefundable Credits (enter the code and amount of each credit)                              Code   Amount
See instructions for codes.                                                                                         •              .00

                                                                                                                    •              .00

                                                                                                                    •              .00

                                                                                                                    •              .00

    a. Total apportionable nonrefundable credits                                                                      a.           .00

   b. Less apportionable nonrefundable credit distributed to beneficiaries on Schedule K-1                          • b. 91        .00

   c. Total apportionable nonrefundable credits claimed by fiduciary                                                  c.           .00
      (subtract credit allocated to beneficiaries from total credit and enter this amount on TC-41, page 2, line 24)
Part 4 - Nonapportionable Nonrefundable Credits (enter the code and amount of each credit)                           Code   Amount
See instructions for codes.                                                                                         •              .00
       
      If using credit 02 (Qualified Sheltered Workshop),                                                            •              .00
      enter the sheltered workshop’s name:
                                                                                                                    •              .00

                                                                                                                    •              .00

    a. Total nonapportionable nonrefundable credits                                                                   a.           .00

    b. Less nonapportionable nonrefundable credit distributed to beneficiaries on Schedule K-1                      • b. 92        .00

   c.  Total nonapportionable nonrefundable credits claimed by fiduciary                                              c.           .00
      (subtract credit allocated to beneficiaries from total credit and enter this amount on TC-41, page 2, line 27)

                                                          Submit page ONLY if data entered.
                                        Attach completed schedule to your Utah Fiduciary Tax Return.

        Fiduciary Supplemental Schedule (continued)                                                                  TC-41A Pg. 2
41204   EIN or SSN                Estate/trust name                                                                  2022
USTC ORIGINAL FORM

Part 5 - Refundable Credits (write the code and amount of each refundable credit)                             Code   Amount
  See instructions for codes.                                                                                •              .00

                                                                                                             •              .00

                                                                                                             •              .00
                                   
                                                                                                             •              .00

    a. Total refundable credits                                                                                a.           .00

    b. Less refundable credit distributed to beneficiaries on Schedule K-1                                   • b. 93        .00

    c. Total refundable credits claimed by fiduciary or trust                                                 c.            .00
       (subtract credit allocated to beneficiaries from total credit and enter this amount on TC-41, line 36)

                                  Submit page ONLY if data entered.
                                 Attach completed schedule to your Utah Fiduciary Tax Return.

       Non and Part-year Resident Estate or Trust Schedule                                                           TC-41B
41205  EIN or SSN                                 Estate/trust name                                                  2022
USTC ORIGINAL FORM
Residency Status:

   •   Nonresident. Home state abbreviation:                            •        Part-year resident from:  /  /      to    /  /
                                                                                                           mm/dd/yy        mm/dd/yy
Income                                                                                     Column A - Utah           Column B - Total

1  Interest income (1041 line 1)                                                                           .00                       .00
2  Total ordinary dividends (1041 line 2a)                                                                 .00                       .00
3  Business income or loss (1041 line 3)                                                                   .00                       .00
4  Capital gain or loss (1041 line 4)                                                                      .00                       .00
5  Rental, royalties, partnerships, other estates and trusts, etc. (1041 line 5)                           .00                       .00
6  Farm income or loss (1041 line 6)                                                                       .00                       .00
7  Ordinary gain or loss (1041 line 7)                                                                     .00                       .00
8  Other income (1041 line 8)                                                                              .00                       .00
9  Additions to income from TC-41A, Part 1 (Utah portion only in Utah column)                              .00                       .00

10  Total income/loss - add lines 1 through 9 for both columns A and B                                     .00                       .00

Deductions                                                                                 Column A - Utah           Column B - Total

11 Fiduciary fees for administrating trust and deducted on federal return (1041 line 12)                   .00                       .00
12  Income distribution deduction (1041 line 18)                                                           .00                       .00
13  Estate tax deduction, including certain generation-skipping taxes (1041 line 19)                       .00                       .00
14  Exemption (1041 line 21)                                                                               .00                       .00
15  State tax refund included in federal income                                                            .00                       .00
16  Subtractions from income from TC-41A, Part 2 (Utah portion only in Utah column)                        .00                       .00

17  Total deductions - add lines 11 through 16 for both columns A and B                                    .00                       .00

18  Subtract line 17 from line 10 for both columns A and B                               •                 .00   •                   .00
       Line 18, column B must equal TC-41, line 14

Non or Part-year Resident Estate or Trust Tax

19  Divide line 18 column A by line 18 column B (to 4 decimal places)                                            19
       Do not enter a number greater than 1.0000 or less than 0.0000
20  Enter tax amount from TC-41, line 25                                                                         20                  .00

21  Multiply line 20 by the decimal on line 19. This is your Utah tax. Enter on TC-41, page 2, line 26         •  21                 .00

                                                  Submit page ONLY if data entered.
                                         Attach completed schedule to your Utah Fiduciary Tax return.

             Bankruptcy Estate Schedule                                                                             TC-41C Pg. 1
41206        EIN or SSN                                 Estate/trust name                                           2022
USTC ORIGINAL FORM

Trustee (or debtor-in-possession)                                                                        Trustee SSN

1  Federal total income (see instructions)                                                                    • 1          .00

2  Federal adjustments from federal form 1040, Schedule 1, line 26                                            • 2          .00

3  Federal adjusted gross income (subtract line 2 from line 1)                                                  3          .00

4  Additions to income (enter code and amount below and total on line 4 (see codes in TC-40 instructions)
                            Code      Amount                                  Code Amount

                   • 4a                                            .00 • 4b                              .00

                   • 4c                                            .00 • 4d                              .00    4          .00
  
5  Add lines 3 and 4                                                                                            5          .00

6  State tax refund included on federal form 1040, Schedule 1, line 1                                         • 6          .00

7  Subtractions from income (enter code and amount below and total on line 7 (see codes in TC-40 instructions)
                            Code      Amount                                  Code Amount

                   • 7a                                            .00 • 7b                              .00

                   • 7c                                            .00 • 7d                              .00    7          .00
  
8  Utah taxable income/loss - subtract the total of lines 6 and 7 from line 5                                 • 8          .00

9  Utah tax - multiply line 8 by 4.85% (.0485) (not less than zero)                                           • 9          .00

  10  Personal exemption (zero in 2022)                                  10              0
  
11  Enter greater of $12,950 or federal itemized deductions            •  11                 .00

12  Add line 10 and line 11                                              12                  .00

13  State income tax deducted on federal Schedule A, line 5a           •  13                 .00

14  Subtract line 13 from line 12                                        14                  .00

15  Initial credit before phase-out - multiply line 14 by 6% (.06)     •  15                 .00

  16  Base phase-out amount                                              16        15,548

17  Phase-out income - subtract line 16 from line 8 (not less than zero)   17                .00

18  Phase-out amount - multiply line 17 by 1.3% (.013)                 •  18                 .00

19  Taxpayer tax credit - subtract line 18 from line 15 (not less than zero)                                  • 19         .00

20 Utah income tax - Subtract line 19 from line 9 (not less than zero)                                        • 20         .00
     Enter the tax from line 20 on TC-41, page 1 line 22
     Note: Non or part-year resident bankruptcy estate must also complete TC-41C, page 2

                                                       Submit this page ONLY if data entered.
                                           Attach completed schedule to your Utah Fiduciary Tax Return.

           Bankruptcy Estate Schedule                                                                                           TC-41C Pg. 2
41207      Non or Part-year Resident (continued)                                                                                2022
           EIN or SSN                                      Estate/trust name
USTC ORIGINAL FORM
Residency Status:      •       Nonresident: Home state abbreviation:           •              Part-year resident from: /  /     to     /  /
                                                                                                                       mm/dd/yy     mm/dd/yy

Income                                                                                          Column A - Utah                 Column B - Total
21  Wages, salaries, tips, etc.(1040 line 1z)                                                                    .00                            .00
22  Taxable interest income (1040 line 2b)                                                                       .00                            .00
23  Ordinary dividends (1040 line 3b)                                                                            .00                            .00
24  IRAs, pensions and annuities - taxable amount (1040 lines 4b and 5b)                                         .00                            .00
25  Social Security benefits - taxable amount (1040 line 6b)                                                     .00                            .00
26  Taxable refunds/credits/offsets of state/local income tax (1040, Schedule 1, line 1)                         .00                            .00
27  Alimony received (1040, Schedule 1, line 2a)                                                                 .00                            .00
28  Business income or loss (1040, Schedule 1, line 3)                                                           .00                            .00
29  Capital gain or loss (1040, line 7)                                                                          .00                            .00
30  Other gains or losses (1040, Schedule 1, line 4)                                                             .00                            .00
31  Rental real estate, royalties, partnerships, S corps, trusts, etc. (1040, Schd 1, line 5)                    .00                            .00
32  Farm income or loss (1040, Schedule 1, line 6)                                                               .00                            .00
33  Unemployment compensation (1040, Schedule 1, line 7)                                                         .00                            .00
34  Other income (1040, Schedule 1, line 9)                                                                      .00                            .00
35  Additions to income from TC-40A, Part 1 (Utah portion only in Utah column)                                   .00                            .00
36 Reserved                                                                                                      .00                            .00
37 Reserved                                                                                                      .00                            .00
38  Total income/loss - add lines 21 through 37 for both columns A and B                                         .00                            .00

Adjustments                                                                                     Column A - Utah                 Column B - Total
39  Educator expenses (1040, Schedule 1, line 11)                                                                .00                            .00
40  Certain business expenses (1040, Schedule 1, line 12)                                                        .00                            .00
41  Health savings account deduction (1040, Schedule 1, line 13)                                                 .00                            .00
42  Moving expenses (1040, Schedule 1, line 14) - col. A only expenses moving into Utah                          .00                            .00
43  Deductible part of self-employment tax (1040, Schedule 1, line 15)                                           .00                            .00
44  Self-employed SEP, SIMPLE and qualified plans (1040, Schedule 1, line 16)                                    .00                            .00
45  Self-employed health insurance deduction (1040, Schedule 1, line 17)                                         .00                            .00
46  Penalty on early withdrawal of savings (1040, Schedule 1, line 18)                                           .00                            .00
47  Alimony paid (1040, Schedule 1, line 19a)                                                                    .00                            .00
48  IRA deduction (1040, Schedule 1, line 20)                                                                    .00                            .00
49  Student loan interest deduction (1040, Schedule 1, line 21)                                                  .00                            .00
50 Reserved                                                                                                      .00                            .00
51 Reserved                                                                                                      .00                            .00
52  State tax refund included on federal form 1040, Schedule 1, line 1                                           .00                            .00
53  Subtractions from income from TC-40A, Part 2 (Utah portion only in Utah column)                              .00                            .00
54 Reserved                                                                                                      .00                            .00
55 Reserved                                                                                                      .00                            .00
56 (see instructions):                                                                                           .00                            .00
57  Total adjustments - add lines 39 through 56 for both columns A and B                                         .00                            .00

58  Subtract line 57 from line 38 for both columns A and B                                    •                  .00     •                      .00
  Line 58, column B must equal TC-41C, page 1, line 8

Non or Part-year Resident Bankruptcy Estate Tax
59  Divide line 58 column A by line 58 column B (to 4 decimal places, not more than 1.0000 or less than 0.0000)      59
                                                                                                                   
60  Enter tax amount from TC-41, line 25                                                                                 60                     .00

61  UTAH TAX - Multiply line 60 by the decimal on line 59. Enter on TC-41,  line 26                                    •  61                    .00
                                                      Submit this page ONLY if data entered.
                                        Attach completed schedule to your Utah Fiduciary Tax Return.

                                              Schedule K - Beneficiaries’ Share of Income, Deductions and Credits                                    TC-41K
41208                                         EIN or SSN                                 Estate/trust name                                           2022
USTC ORIGINAL FORM

                                            Ź  Number of Schedules K-1 attached to this return:                •

                                                                                                                                  Federal Amount     Utah Amount
                                            1a  U.S. government interest income                                                                  .00              .00
                                            1b  Municipal bond interest income                                                                   .00              .00
                                            1c  Other interest income                                                                            .00              .00
                                            2 Ordinary dividends                                                                                 .00              .00

                                            3  Net short-term capital gain                                                                       .00              .00
                                            4  Net long-term capital gain                                                                        .00              .00
           Income/Loss
                                            5  Other portfolio and nonbusiness income                                                            .00              .00
                                            6  Ordinary business income                                                                          .00              .00

                                            7  Net rental real estate income                                                                     .00              .00
                                            8  Other rental income                                                                               .00              .00

                                            9  Directly apportioned deductions (describe)
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00

                                            10  Estate tax deduction                                                                             .00              .00
                                            11  Final year deductions (describe)
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00

                                            12 Other information
                                                                                                                                                 .00              .00
           Deductions and Other Information                                                                                                      .00              .00
                                                                                                                                                 .00              .00
                                                                                                                                                 .00              .00

                                            13  Utah nonrefundable credits - enter the name of the Utah credit                      Code             Credit Amount
                                                                                                                                                                  .00
                                                                                                                                                                  .00
                                                                                                                                                                  .00
                                                                                                                                                                  .00

                                            14  Utah refundable credits - enter the name of the Utah credit                         Code             Credit Amount
                                                                                                                                  •                               .00

   Utah Credits                                                                                                                   •                               .00

                                                                                                                                  •                               .00

                                                                                                                                  •                               .00

                                            15  Total Utah tax withheld on behalf of all beneficiaries from Schedule N, column J                                  .00

                                                                             Attach completed schedule to your Utah Fiduciary Tax return.

      Schedule K-1 - Beneficiary’s Share of Income, Deductions and Credits                                            TC-41K-1
41209 EIN or SSN                                         Estate/trust name                                            2022
USTC ORIGINAL FORM
Estate or Trust Information                                             Beneficiary’s Share of Utah Income, Deductions and Credits
                                                                        1a Utah U.S. government interest income                    .00
A  Estate or trust EIN or SSN:                                          1b Utah taxable municipal bond interest income             .00
                                                                        1c Utah other interest income                              .00
B  Estate or trust name                                                 2  Utah ordinary dividends                                 .00

                                                                        3  Utah net short-term capital gain                        .00
                                                                        4  Utah net long-term capital gain                         .00
Fiduciary Information
                                                                        5  Utah portfolio and nonbusiness income                   .00
C  Fiduciary name, address, city, state, and ZIP code                   6  Utah ordinary business income                           .00

                                                                        7  Utah net rental real estate income                      .00
                                                                        8  Utah other rental income                                .00

                                                                        9  Utah directly apportioned deductions (describe)
Beneficiary Information                                                                                                            .00
                                                                                                                                   .00
D  Beneficiary’s EIN or SSN                                                                                                        .00
                                                                                                                                   .00
E  Beneficiary’s name, address, city, state, and ZIP code
                                                                        10 Estate tax deduction                                    .00
                                                                        11 Final year Utah deductions (describe)
                                                                                                                                   .00
                                                                                                                                   .00
                                                                                                                                   .00
F  Beneficiary’s phone number                                                                                                      .00

G  Percent of Utah income distributed to                                12 Other Utah information
 the beneficiary                                                                                                                   .00
H  Dependent Beneficiary - enter “X”                                                                                               .00
 “Statement of Dependent Beneficiary Income” on file with trustee                                                                  .00
 (See Schedule N instructions for definition of dependent beneficiary.)                                                            .00
Other Information
                                                                        13 Utah nonrefundable credits distributed to beneficiary
                                                                           Name of credit                          Code      Amount
                                                                                                                                   .00
                                                                                                                                   .00
                                                                                                                                   .00
                                                                                                                                   .00

                                                                        14 Utah refundable credits distributed to beneficiary
                                                                           Name of Credit                          Code      Amount
                                                                                                                                   .00
                                                                                                                                   .00
Tax Commission Use Only:                                                                                                           .00
                                                                                                                                   .00

                                                                        15 Utah tax withheld on behalf of beneficiary              .00
                                                                              “X” if withholding waiver applied for

               Schedule N - Pass-through Entity Withholding Tax                                                                     TC-41N
41210          EIN or SSN                                          Estate/trust name                                                2022
USTC ORIGINAL FORM
An estate or trust with nonresident individual beneficiaries, resident/nonresident business beneficiaries, or resident/nonresident trust or estate 
beneficiaries must complete the information below to report the Utah income and to calculate the Utah withholding tax for these beneficiaries.
                                                                                      .
WITHHOLDING WAIVER CLAIMED under §59-10-1403.2(5): If beneficiaries will pay the Utah tax on their own returns:                  •
 Enter " " to1claim a waiver for ALL beneficiaries (enter " " in columnX B and " " in column0F for all beneficiaries)
 Enter " " to2claim a waiver for SOME beneficiaries (enter " " in columnX  B and " " in column0F for those beneficiaries claimed)
    See Schedule N instructions for liability responsibilities when claiming a waiver.
A   Name of beneficiary                                          F Income/loss            G  4.85% of income -       H Mineral production J Withholding tax
B   Withholding waiver for this beneficiary                        attributable to Utah        F times 4.85% (.0485)  withholding credit    to be paid by
    (enter “ ” inXcolumn   andB“ ” in column 0 )   F                                           (not less than zero)                         this fiduciary 
C   “X” if Dependent Beneficiary                                                                                     I Upper-tier pass-     (G less H and I -
D   SSN or EIN of Beneficiary         E  Beneficiary’s % of income                                                     through withholding  not less than 0)

#1 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#2 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#3 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#4 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#5 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#6 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

#7 A                                                             F                    .00 G                   .00    H           .00      J                .00

 •  B                              • C                                                                               I           .00

 •  D                                 E

    Report the beneficiary’s pass-through withholding                      Total Utah withholding tax to be paid by this fiduciary:                        .00
    tax from column J on Schedule K-1, line 15                               Enter on TC-41, line 31 and on Sch. K, line 15. 

      Credit for Income Tax Paid to Another State                                                      TC-41S
41211 EIN or SSN                                              Estate/trust name                        2022

NOTE: Part-year resident estates/trusts rarely qualify for this credit. Nonresident estates/trusts do not qualify for this credit. See instructions.
FIRST STATE
  1  Enter only taxable income taxed by both Utah and state of:                                1    .00

  2  Utah taxable income from TC-41 line 14, or TC-41C line 8, if applicable                   2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.    3

  4  Utah fiduciary tax from TC-41, line 22. Part-year residents, see instructions.            4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual fiduciary tax paid to state shown on line 1                                        6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                    7     .00

SECOND STATE
  1  Enter only taxable income taxed by both Utah and state of:                                1    .00

  2  Utah taxable income from TC-41 line 14, or TC-41C line 8, if applicable                   2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.    3

  4  Utah fiduciary tax from TC-41, line 22. Part-year residents, see instructions.            4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual fiduciary tax paid to state shown on line 1                                        6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                    7     .00

THIRD STATE
  1  Enter only taxable income taxed by both Utah and state of:                                1    .00

  2  Utah taxable income from TC-41 line 14, or TC-41C line 8, if applicable                   2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.    3

  4  Utah fiduciary tax from TC-41, line 22. Part-year residents, see instructions.            4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual fiduciary tax paid to state shown on line 1                                        6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                    7     .00

                 Use additional forms TC-41S if claiming credits for more than three states.
                 Enter the total of all amounts shown line 7 above on TC-41A, Part 4, using code 17.
                                                              Submit page ONLY if data entered.
                 Attach completed schedule to your Utah Fiduciary Tax return.

      Part 1 - Utah Withholding Tax Schedule                                                              TC-41W                      Pg. 1
41212 EIN or SSN                                      Estate/trust name                                   2022
USTC ORIGINAL FORM

   Line Explanations                                              IMPORTANT

    1  Employer/payer ID number from W-2 box “b” or 1099          Do not send your W-2s or 1099s with your return. Instead enter
    2  Utah withholding ID number from W-2 box “15” or 1099       W-2 or 1099 information below, but only if there is Utah withholding
     (14 characters, ending in WTH, no hyphens)                   on the form.
    3  Employer/payer name and address from W-2 box “c” or 1099
    4  Enter “X” if reporting Utah withholding from form 1099     Use additional forms TC-41W if you have more than four W-2s and/or
    5  Employee’s Social Security number from W-2 box “a” or 1099 1099s with Utah withholding tax.
    6  Utah wages or income from W-2 box “16” or 1099
    7  Utah withholding tax from W-2 box “17” or 1099             Enter mineral production withholding from TC-675R in Part 2 of TC-41W;
                                                                  enter pass-through entity withholding in Part 3 of TC-41W.

First W-2 or 1099                                                 Second W-2 or 1099
 1                                                                1

  2                      (14 characters, no hyphens)              2                                       (14 characters, no hyphens)

 3                                                                3

 4                                                                4

 5                                                                5

 6                   .00                                          6                    .00

 7                   .00                                          7                    .00

Third W-2 or 1099                                                 Fourth W-2 or 1099
 1                                                                1

  2                      (14 characters, no hyphens)              2                                       (14 characters, no hyphens)

 3                                                                3

 4                                                                4

 5                                                                5

 6                   .00                                          6                    .00

 7                   .00                                          7                    .00

                         Enter total Utah withholding tax from all lines 7 here and on TC-41, line 33:                                .00

                                                      Submit page ONLY if data entered.
                         Attach completed schedule to your Utah Fiduciary Tax Return.
                         Do not attach W-2s or 1099s to your Utah return.

      Mineral Production and Pass-through Withholding                                                            TC-41W Pg. 2
41213 EIN or SSN                                       Estate/trust name                                         2022
USTC ORIGINAL FORM
Part 2 -Utah Mineral Production Withholding Tax - TC-675R
  Do not send TC-675R or Utah Schedules K-1 with return. Enter TC-675R or Schedule K-1 information below. Use additional TC-41Ws if needed.
   Line Explanations
    1  Producer’s EIN number from box “2” of TC-675R              4  Pass-through entity EIN if credit from partnership or S corporation
    2  Producer’s name from box “1” of TC-675R                           (enter EIN from Utah Schedule K-1)
    3  Producer’s Utah withholding number from box “3” of TC-675R 5  Utah mineral production withholding tax from box”6” of TC-675R or
     (14 characters, ending in WMP, no hyphens)                          from Utah Schedule K-1.
  First TC-675R or Utah Schedule K-1                              Second TC-675R or Utah Schedule K-1
 1                                                                1

 2                                                                2

  3                                  (14 characters, no hyphens)  3                                        (14 characters, no hyphens)

 4                                                                4

 5                      .00                                       5                     .00

Third TC-675R or Utah Schedule K-1                                Fourth TC-675R or Utah Schedule K-1
 1                                                                1

 2                                                                2

  3                                  (14 characters, no hyphens)  3                                        (14 characters, no hyphens)

 4                                                                4

 5                      .00                                       5                     .00

      Enter total mineral production withholding tax from all lines 5 here and on TC-41A, Part 5, using code 46.                           .00

Part 3 -Utah Pass-through Entity Taxpayer Withholding - Utah Schedule K-1
  Do not send Utah Schedule(s) K-1 with return. Enter information below. Use additional TC-41Ws if needed.
   Line Explanations
    1  Pass-through entity EIN from Utah Schedule K-1 box “A”
    2  Name of pass-through entity from Utah Schedule K-1 box “B”
    3  Utah withholding tax paid by pass-through entity
First Utah Schedule K-1                                           Second Utah Schedule K-1
 1                                                                1

 2                                                                2

 3                      .00                                       3                     .00

Third Utah Schedule K-1                                           Fourth Utah Schedule K-1
 1                                                                1

 2                                                                2

 3                      .00                                       3                     .00

      Enter total pass-through withholding tax from all lines 3 here and on TC-41A, Part 5, using code 43:                                 .00

                                                       Submit page ONLY if data entered.
                                     Attach completed schedule to your Utah Fiduciary Tax Return.

      Credits Received from Upper-tier Pass-through Entities                              TC-250
25201 and Mineral Production Withholding Tax Credit on TC-675R                            2022
      EIN                                                                                 (use with TC-20S, TC-41 and TC-65)
USTC ORIGINAL FORM
Part 1 - Utah Nonrefundable Credits Received from Upper-tier Pass-through Entities
     Upper-tier pass-through                                                                     UT nonrefundable
     entity EIN from Utah    Name of upper-tier pass-through entity                       Credit credit from
     Sch. K-1, box “A”       from Utah Schedule K-1, box “B”                              Code   Utah Sch. K-1

1
2
3
4
5
6

  Enter these credits on Utah TC-20S Sch. K, line 18, or TC-41 Sch. A, Part 3 or 4, or TC-65 Sch. K, line 17, using the credit code above.
  Combine amounts for the same codes.

Part 2 - Utah Refundable Credits Received from Upper-tier Pass-through Entities
     Upper-tier pass-through
     entity EIN from Utah    Name of upper-tier pass-through entity                       Credit UT refundable credit
     Sch. K-1, box “A”       from Utah Schedule K-1, box “B”                              Code   from Utah Sch. K-1

1
2
3
4
5
6
7
8
9
10
11
12
13
14

  Enter these credits on Utah TC-20S Sch. K, line 19, or TC-41 Sch. A, Part 5, or TC-65 Sch. K, line 18, using the credit code above.
  Combine amounts for the same codes.

Part 3 - Utah Mineral Production Withholding Tax Credit Received on TC-675R
                                                                                                 Mineral production
     Producer EIN from                                                                           withholding from
     TC-675R, box “2”        Producer’s name from TC-675R, box “1”                               TC-675R, box “6”

1
2
3
4
5
6
7
8
9
10

                  Total Utah mineral production withholding tax credit received on TC-675R
                    Enter total credit on Utah TC-20S Sch. K, line 19, or TC-41 Sch. A, Part 5, or TC-65 Sch. K, line 18, using credit code 46.

           Statement of Dependent Beneficiary Income          TC-41DB
           Required by Utah Code §59-10-1402(17)              2022
USTC ORIGINAL FORM
By signing below, I declare that, for the taxable year ending _____ /_____ /20_____, I have or will claim the beneficiary named below as a dependent on 
my federal income tax return.

Name of dependent beneficiary                             Dependent’s Social Security Number

I attest that the dependent named above is a beneficiary of a trust that is a pass-through entity, and the dependent’s federal adjusted gross income for 
the taxable year does not exceed the basic standard deduction calculated under Internal Revenue Code Section 63 for the taxable year.

Signed                                                    Date

Print name                                                Taxpayer’s Social Security Number

Instructions:
 1  Give this form to the fiduciary estate or trust.
 2  Keep a copy with your tax records.
 3  Do not send a copy of this form to the Tax Commission.
 4  This statement must be kept by the trustee of the trust and made available to the Tax Commission upon request (Utah Code §59-10-1403.2(6)).