Form 1042-S Foreign Person's U.S. Source Income Subject to Withholdi

Form

1042-S

Department of the Treasury
Internal Revenue Service

Foreign Person’s U.S. Source Income
Subject to Withholding
AMENDED

1 Income 2 Gross income
code

3 Withholding
allowances

2008

PRO-RATA BASIS REPORTING
4 Net income

5 Tax
rate

OMB No. 1545-0096

Copy A for
Internal Revenue Service

6 Exemption 7 Federal tax withheld
code
8 Withholding by other agents
9 Total withholding credit

10 Amount repaid to recipient
11 Withholding agent’s EIN

©

EIN
12a WITHHOLDING AGENT’S name

©

14

Recipient’s U.S. TIN, if any

15

SSN or ITIN
EIN
Recipient’s foreign tax identifying number, if any

QI-EIN
16 Country code

17

NQI’s/FLOW-THROUGH ENTITY’S name

18 Country code

QI-EIN

12b Address (number and street)

19a NQI’s/Entity’s address (number and street)

12c Additional address line (room or suite no.)

19b Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

19c City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name

13b Recipient code 20

NQI’s/Entity’s U.S. TIN, if any

©

13c Address (number and street)

21

PAYER’S name and TIN (if different from withholding agent’s)

13d Additional address line (room or suite no.)

22

Recipient account number (optional)

13e City or town, province or state, country, ZIP or foreign postal code

23

State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 16 of the separate instructions.

Cat. No. 11386R

Form

1042-S

(2008)

Form

1042-S

Department of the Treasury
Internal Revenue Service

Foreign Person’s U.S. Source Income
Subject to Withholding
AMENDED

1 Income 2 Gross income
code

3 Withholding
allowances

2008

OMB No. 1545-0096

PRO-RATA BASIS REPORTING
4 Net income

5 Tax
rate

Copy B
for Recipient

6 Exemption 7 Federal tax withheld
code
8 Withholding by other agents
9 Total withholding credit

10 Amount repaid to recipient
11 Withholding agent’s EIN

©

EIN
12a WITHHOLDING AGENT’S name

©

14

Recipient’s U.S. TIN, if any

15

SSN or ITIN
EIN
Recipient’s foreign tax identifying number, if any

QI-EIN
16 Country code

17

NQI’s/FLOW-THROUGH ENTITY’S name

18 Country code

QI-EIN

12b Address (number and street)

19a NQI’s/Entity’s address (number and street)

12c Additional address line (room or suite no.)

19b Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

19c City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name

13b Recipient code 20

NQI’s/Entity’s U.S. TIN, if any

©

13c Address (number and street)

21

PAYER’S name and TIN (if different from withholding agent’s)

13d Additional address line (room or suite no.)

22

Recipient account number (optional)

13e City or town, province or state, country, ZIP or foreign postal code

23

State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 16 of the separate instructions.

Cat. No. 11386R

Form

1042-S

(2008)

U.S. Income Tax Filing Requirements
Generally, every nonresident alien individual, nonresident alien
fiduciary, and foreign corporation with United States income,
including income that is effectively connected with the conduct of a
trade or business in the United States, must file a United States
income tax return. However, no return is required to be filed by a
nonresident alien individual, nonresident alien fiduciary, or a foreign
corporation if such person was not engaged in a trade or business in
the United States at any time during the tax year and if the tax
liability of such person was fully satisfied by the withholding of
United States tax at the source. (Corporations file Form 1120-F; all
others file Form 1040NR (or Form 1040NR-EZ if eligible).) You may
get the return forms and instructions at any United States Embassy
or consulate or by writing to: National Distribution Center, P.O. Box
8903, Bloomington, IL 61702-8903, U.S.A.
En règle générale, tout étranger non-résident, tout organisme
fidéicommissaire étranger non-résident et toute société étrangère
percevant un revenu aux Etats-Unis, y compris tout revenu dérivé,
en fait, du fonctionnement d’un commerce ou d’une affaire aux
Etats-Unis, doit soumettre aux Etats-Unis, une déclaration d’impôt
sur le revenu. Cependant aucune déclaration d’impôt sur le revenu
n’est exigée d’un étranger non-résident, d’un organisme
fidéicommissaire étrange non-résident, ou d’une société étrangère
s’ils n’ont pris part à aucun commerce ou affaire aux Etats-Unis à
aucun moment pendant l’année fiscale et si les impôts dont ils sont
redevables, ont été entièrement acquittés par une retenue à la
source, de leur montant. (Les sociétés doivent faire leur déclaration
d’impôt en remplissant le formulaire 1120-F; tous les autres
redevables doivent remplir le formulaire 1040NR (ou 1040NR-EZ si
éligible).) On peut se procurer formulaires de déclarations d’impôts et
instructions dans toutes les Ambassades et tous les Consulats des
Etats-Unis. L’on peut également s’adresser pour tous
renseignements a: National Distribution Center, P.O. Box 8903,
Bloomington, IL 61702-8903, U.S.A.

Por regla general, todo extranjero no residente, todo organismo
fideicomisario extranjero no residente y toda sociedad anónima
extranjera que reciba ingresos en los Estados Unidos, incluyendo
ingresos relacionados con la conducción de un negocio o comercio
dentro de los Estados Unidos, deberá presentar una declaración
estadounidense de impuestos sobre ingreso. Sin embargo, no se
requiere declaración alguna a un individuo extranjero, una sociedad
anónima extranjera u organismo fideicomisario extranjero no
residente, si tal persona no ha efectuado comercio o negocio en los
Estados Unidos durante el año fiscal y si la responsabilidad con los
impuestos de tal persona ha sido satisfecha plenamente mediante
retencion del impuesto de los Estados Unidos en la fuente. (Las
sociedades anónimas envian la Forma 1120-F; todos los demás
contribuyentes envian la Forma 1040NR (o la Forma 1040NR-EZ si le
corresponde).) Se podrán obtener formas e instrucciones en
cualquier Embajada o Consulado de los Estados Unidos o
escribiendo directamente a: National Distribution Center,
P.O. Box 8903, Bloomington, IL 61702-8903, U.S.A.
Im allgemeinen muss jede ausländische Einzelperson, jeder
ausländische Bevollmächtigte und jede ausländische Gesellschaft mit
Einkommen in den Vereinigten Staaten, einschliesslich des
Einkommens, welches direkt mit der Ausübung von Handel oder
Gewerbe innerhalb der Staaten verbunden ist, eine
Einkommensteuererklärung der Vereinigten Staaten abgeben. Eine
Erklärung, muss jedoch nicht von Ausländern, ausländischen
Bevollmächtigten oder ausländischen Gesellschaften in den
Vereinigten Staaten eingereicht werden, falls eine solche Person
während des Steuerjahres kein Gewerbe oder Handel in den
Vereinigten Staaten ausgeübt hat und die Steuerschuld durch
Einbehaltung der Steuern der Vereinigten Staaten durch die
Einkommensquelle abgegolten ist. (Gesellschaften reichen den
Vordruck 1120-F ein; alle anderen reichen das Formblatt 1040NR
oder wenn passend das Formblatt 1040NR-EZ ein.)
Einkommensteuererklärungen und Instruktionen können bei den
Botschaften und Konsulaten der Vereiningten Staaten eingeholt
werden. Um weitere Informationen wende man sich bitte an: National
Distribution Center, P.O. Box 8903, Bloomington, IL 61702-8903,
U.S.A.

Form

1042-S

Department of the Treasury
Internal Revenue Service

Foreign Person’s U.S. Source Income
Subject to Withholding
AMENDED

1 Income 2 Gross income
code

3 Withholding
allowances

2008

PRO-RATA BASIS REPORTING
4 Net income

5 Tax
rate

OMB No. 1545-0096

Copy C

for Recipient

Attach to any Federal tax return you file

6 Exemption 7 Federal tax withheld
code
8 Withholding by other agents
9 Total withholding credit

10 Amount repaid to recipient
11 Withholding agent’s EIN

©

EIN
12a WITHHOLDING AGENT’S name

©

14

Recipient’s U.S. TIN, if any

15

SSN or ITIN
EIN
Recipient’s foreign tax identifying number, if any

QI-EIN
16 Country code

17

NQI’s/FLOW-THROUGH ENTITY’S name

18 Country code

QI-EIN

12b Address (number and street)

19a NQI’s/Entity’s address (number and street)

12c Additional address line (room or suite no.)

19b Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

19c City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name

13b Recipient code 20

NQI’s/Entity’s U.S. TIN, if any

©

13c Address (number and street)

21

PAYER’S name and TIN (if different from withholding agent’s)

13d Additional address line (room or suite no.)

22

Recipient account number (optional)

13e City or town, province or state, country, ZIP or foreign postal code

23

State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 16 of the separate instructions.

Cat. No. 11386R

Form

1042-S

(2008)

Explanation of Codes

Other

Dividend

Interest

Box 1. Income code.
Code
Types of Income
01 Interest paid by U.S. obligors—general
02 Interest paid on real property mortgages
03 Interest paid to controlling foreign corporations
04 Interest paid by foreign corporations
05 Interest on tax-free covenant bonds
29 Deposit interest
30 Original issue discount (OID)
31 Short-term OID
33 Substitute payment—interest
06
07
08
34

Dividends paid by U.S. corporations—general
Dividends qualifying for direct dividend rate
Dividends paid by foreign corporations
Substitute payment—dividends

09
10
11
12
13
14
15
16
17
18
19
20
24
25
26

Capital gains
Industrial royalties
Motion picture or television copyright royalties
Other royalties (for example, copyright, recording, publishing)
Real property income and natural resources royalties
Pensions, annuities, alimony, and/or insurance premiums
Scholarship or fellowship grants
Compensation for independent personal services1
Compensation for dependent personal services1
Compensation for teaching1
Compensation during studying and training1
Earnings as an artist or athlete2
Real estate investment trust (REIT) distributions of capital gains
Trust distributions subject to IRC section 1445
Unsevered growing crops and timber distributions by a trust subject
to IRC section 1445
Publicly traded partnership distributions subject to IRC section 1446
6
Gambling winnings
3
Notional principal contract income
Substitute payment—other
Capital gains distributions
Return of capital
Other income

27
28
32
35
36
37
50
1

Box 6. Exemption code (applies if the tax rate entered in box 5 is 00.00).
Code
Authority for Exemption
01
Income effectively connected with a U.S. trade or business
02
Exempt under an Internal Revenue Code section (income other than
portfolio interest)
03
Income is not from U.S. sources4
04
Exempt under tax treaty
05
Portfolio interest exempt under an Internal Revenue Code section
06
Qualified intermediary that assumes primary withholding responsibility
07
Withholding foreign partnership or withholding foreign trust
08
U.S. branch treated as a U.S. person
09
Qualified intermediary represents income is exempt
Box 12. Recipient code.
Code
Type of Recipient
01
Individual2
02
Corporation2
03
Partnership other than withholding foreign partnership2
04
Withholding foreign partnership or withholding foreign trust
05
Trust
06
Government or international organization
07
Tax-exempt organization (IRC section 501(a))
08
Private foundation
09
Artist or athlete2
10
Estate
11
U.S. branch treated as U.S. person
12
Qualified intermediary
13
Private arrangement intermediary withholding rate pool—general5
14
Private arrangement intermediary withholding rate pool—
exempt organizations5
15
Qualified intermediary withholding rate pool—general5
16
Qualified intermediary withholding rate pool—exempt organizations5
17
Authorized foreign agent
18
Public pension fund
20
Unknown recipient

If compensation that otherwise would be covered under Income Codes 16–19 is directly attributable to the recipient’s occupation as an artist or athlete, use Income Code 20 instead.
If Income Code 20 is used, Recipient Code 09 (artist or athlete) should be used instead of Recipient Code 01 (individual), 02 (corporation), or 03 (partnership other than withholding foreign
partnership).
3
Use appropriate Interest Income Code for embedded interest in a notional principal contract.
4
Non-U.S. source income received by a nonresident alien is not subject to U.S. tax. Use Exemption Code 03 when entering an amount for information reporting purposes only.
5
May be used only by a qualified intermediary.
6
Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.
2

Form

1042-S

Department of the Treasury
Internal Revenue Service

Foreign Person’s U.S. Source Income
Subject to Withholding
AMENDED

1 Income 2 Gross income
code

3 Withholding
allowances

2008

PRO-RATA BASIS REPORTING
4 Net income

5 Tax
rate

OMB No. 1545-0096

Copy D

for Recipient

Attach to any state tax return you file

6 Exemption 7 Federal tax withheld
code
8 Withholding by other agents
9 Total withholding credit

10 Amount repaid to recipient
11 Withholding agent’s EIN

©

EIN
12a WITHHOLDING AGENT’S name

©

14

Recipient’s U.S. TIN, if any

15

SSN or ITIN
EIN
Recipient’s foreign tax identifying number, if any

QI-EIN
16 Country code

17

NQI’s/FLOW-THROUGH ENTITY’S name

18 Country code

QI-EIN

12b Address (number and street)

19a NQI’s/Entity’s address (number and street)

12c Additional address line (room or suite no.)

19b Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

19c City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name

13b Recipient code 20

NQI’s/Entity’s U.S. TIN, if any

©

13c Address (number and street)

21

PAYER’S name and TIN (if different from withholding agent’s)

13d Additional address line (room or suite no.)

22

Recipient account number (optional)

13e City or town, province or state, country, ZIP or foreign postal code

23

State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 16 of the separate instructions.

Cat. No. 11386R

Form

1042-S

(2008)

Form

1042-S

Department of the Treasury
Internal Revenue Service

Foreign Person’s U.S. Source Income
Subject to Withholding
AMENDED

1 Income 2 Gross income
code

3 Withholding
allowances

2008

PRO-RATA BASIS REPORTING
4 Net income

5 Tax
rate

OMB No. 1545-0096

Copy E
for Withholding Agent

6 Exemption 7 Federal tax withheld
code
8 Withholding by other agents
9 Total withholding credit

10 Amount repaid to recipient
11 Withholding agent’s EIN

©

EIN
12a WITHHOLDING AGENT’S name

©

14

Recipient’s U.S. TIN, if any

15

SSN or ITIN
EIN
Recipient’s foreign tax identifying number, if any

QI-EIN
16 Country code

17

NQI’s/FLOW-THROUGH ENTITY’S name

18 Country code

QI-EIN

12b Address (number and street)

19a NQI’s/Entity’s address (number and street)

12c Additional address line (room or suite no.)

19b Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

19c City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name

13b Recipient code 20

NQI’s/Entity’s U.S. TIN, if any

©

13c Address (number and street)

21

PAYER’S name and TIN (if different from withholding agent’s)

13d Additional address line (room or suite no.)

22

Recipient account number (optional)

13e City or town, province or state, country, ZIP or foreign postal code

23

State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 16 of the separate instructions.

Cat. No. 11386R

Form

1042-S

(2008)