Form Tc-941 - Utah Withholding Return - Utah State Tax Commission

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94181
Utah State Tax Commission
TC-941
Utah Withholding Return
Rev. 10/15
9998
Utah Account ID
Check here to stop
receiving paper
forms.
Federal EIN
Name and address
Check here to close
your account.
Tax Period (mmddyyyy)
From
To
Due Date (mmddyyyy)
Check if AMENDED
(replacement, not net difference)
•
1. Utah wages, compensation and distributions for this period
1
.
•
2. Federal income tax withheld this period for Utah employees
2
.
•
3. Utah tax withheld this period
3
.
Pay online at taxexpress.utah.gov, or use the payment coupon (form TC-941PC), available at tax.utah.gov/forms.
Under penalties provided by law, I declare to the best of my knowledge this return is true and correct.
Signature
Date
Phone
X
You can save money!
See the instructions and learn about taxexpress.utah.gov.
•
USTC use only

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