Form 1041-T Allocation Estimated Tax Payments to Beneficiaries

Form

1041-T

Allocation of Estimated Tax
Payments to Beneficiaries

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(Under Code section 643(g))

Department of the Treasury
Internal Revenue Service

For calendar year 2009 or fiscal year beginning

Name of trust (or decedent’s estate)

, 2009, and ending

, 20

Telephone number (optional)

(

)

If you are filing this form for the final year
䊳
of the estate or trust, check this box

Total amount of estimated taxes to be allocated to beneficiaries. Enter here and on Form 1041, line 24b
Allocation to beneficiaries:

(a)
No.

(b)
Beneficiary’s name and address

1
2
3
4

2009

Employer identification number

Fill In Fiduciary’s Name and title of fiduciary
Name and
Address Only If
Number, street, and room or suite no. (If a P.O. box, see instructions.)
You Are Filing
This Form
Separately and
City, state, and ZIP code
Not With Form
1041.

1
2

OMB No. 1545-1020

䊳

$

(d)
Amount of estimated
tax payment allocated
to beneficiary

(c)
Beneficiary’s identifying
number

(e)
Proration
percentage

%
%
%
%

5
%
6
%
7
%
8
%
9
%
10
%
3

Total from additional sheet(s)

3

4

Total amounts allocated. (Must equal line 1, above.)

4

Sign Here Only
If You Are Filing
This Form
Separately and
Not With Form
1041.

Under penalties of perjury, I declare that I have examined this allocation, including accompanying schedules and statements, and to the best
of my knowledge and belief, it is true, correct, and complete.

䊳

Signature of fiduciary or officer representing fiduciary

For Paperwork Reduction Act Notice, see back of form.

Date

Cat. No. 64305W

Form

1041-T

(2009)