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Irs Form 1042 2016
Code
number, if any
7b Check if tax not deposited with
IRS pursuant to escrow procedure
7a Federal tax withheld
Copy A for
Internal Revenue Service
13e Recipient's U.S. TIN, if any
5 Withholding allowance
6 Net income
OMB No. 1545-0096
PRO-RATA BASIS REPORTING
3 Chapter indicator. Enter “3” or “4”
3a Exemption code
2016
13l Recipient's date of birth
9 Tax paid by withholding agent
14a Primary Withholding Agent's Name (if applicable)
10 Total withholding credit
11 Amount repaid to...
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