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                                                                   Utah State Tax Commission
                                                                   Discrepancy Report                                    TC-941D
                                                                                                                         Rev. 5/12
                                                                 For Annual Withholding Reconciliation
                                                                 Tax year for this report                 Check box if
                                                                                                          Amended Report

When To Use This Form
If your business changed entity types or merged with another company during the tax year and lines 4 and 6 of your Utah
Annual Withholding Reconciliation, form TC-941R, do not balance, you must file this form explaining the discrepancy and
reconciling the withholding tax returns with the W-2s (or other withholding forms) issued by your company.
Company name                                                                                             Federal employer identification no.

Address                                                                                                  Utah withholding account number

City                                                               State       Zip code                  Telephone number

Check the reason your W-2s and 1099s and/or TC-941R are being filed for more than one Utah Employer Withholding Account.
       Business merged with another business
       Business changed from a sole proprietorship to a partnership, LLC or corporation
       Business changed from a partnership to a sole proprietorship, LLC or corporation
       Business changed from a LLC to a sole proprietorship, partnership or corporation
       Business changed from a corporation to a sole proprietorship, partnership or LLC
       Other (explain): ______________________________________________________________________________

Reconciliation Calculation
          Column A                  Column B                                Column C                      Column D
     Utah employer withholding      Yearly total tax withheld as   Utah withholding tax as                Difference in amounts reported
          account numbers           reported on TC-941R, line 6    reported on TC-941R, line 4           (subtract Column C from Column B)
                                  $                              $                                       $

Totals (Column D must equal zero) $                              $                                       $
Under penalties provided by law, I declare, to the best of my knowledge, this report is true and correct.
Signature                                                        Date signed
X

Instructions For Reconciliation CalculationAbove
Column A: Enter the Utah employer withholding account number of each account for which you filed quarterly Utah Withholding Returns,
TC-941, during the year.
Column B: Enter the sum of the withholding reported onTC-941R, line 6 for each account number.
Column C: Enter the total withholding reported on theTC-941R, line 4 for each account number.
Column D: Subtract Column C from Column B and enter the result. The total of Column D should be zero. If the result is not zero, the
following are possible explanations.
 1. You may have made an error. Check the amounts onTC-941s andTC-941R to ensure you entered the correct figures.
 2. You may have underpaid the withholding tax. If the withholding reported in Column C is greater than the sum of the withholding in
       Column B (i.e., the difference is a negative number in Column D), you have underpaid.
 3. You may have overpaid the withholding tax. If the withholding reported in Column C is less than the sum of the withholding in
       Column B (i.e., the difference is a positive number in Column D), you have overpaid.
You may pay the additional tax or request the refund by filing an amended formTC-941 for the period(s) you either underpaid or overpaid.