DO NOT STAPLE
1042-T
Annual Summary and Transmittal of
OMB No. 1545-0096
Form
Forms 1042-S
2019
Department of the Treasury
Go to www.irs.gov/Form1042T for the latest information.
Internal Revenue Service
Ch. 4 Status Code
Name of withholding agent
Employer identification number
Ch. 3 Status Code
Number, street, and room or suite no.
City or town, state or province, country, and ZIP or foreign postal code
1
Type of paper Forms 1042‐S attached:
a Choose only one:
Chapter 4 or Chapter 3 (enter 4 or 3)
b Check only one box:
Original
Amended
c Check if pro rata
d Enter the number of paper Forms 1042‐S attached
$
2
Total gross income reported on all paper Forms 1042-S (box 2) attached .
.
.
.
.
.
.
.
.
3
Total federal tax withheld on all paper Forms 1042-S attached:
$
a Total federal tax withheld under Chapter 4 .
.
.
.
.
.
.
.
.
.
.
$
b Total federal tax withheld under Chapter 3 .
.
.
.
.
.
.
.
.
.
.
Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld
information shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the
instructions on page 2.
If this is your FINAL return, enter an “X” here (see instructions)
Please return this entire page to the Internal Revenue Service.
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and
belief, they are true, correct, and complete.
Sign
Here
Your signature
Title
Date
Daytime phone number
1042-T
For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.
Cat. No. 28848W
Form
(2019)
DO NOT STAPLE
1042-T
Annual Summary and Transmittal of
OMB No. 1545-0096
Form
Forms 1042-S
2019
Department of the Treasury
Go to www.irs.gov/Form1042T for the latest information.
Internal Revenue Service
Ch. 4 Status Code
Name of withholding agent
Employer identification number
Ch. 3 Status Code
Number, street, and room or suite no.
City or town, state or province, country, and ZIP or foreign postal code
1
Type of paper Forms 1042‐S attached:
a Choose only one:
Chapter 4 or Chapter 3 (enter 4 or 3)
b Check only one box:
Original
Amended
c Check if pro rata
d Enter the number of paper Forms 1042‐S attached
$
2
Total gross income reported on all paper Forms 1042-S (box 2) attached .
.
.
.
.
.
.
.
.
3
Total federal tax withheld on all paper Forms 1042-S attached:
$
a Total federal tax withheld under Chapter 4 .
.
.
.
.
.
.
.
.
.
.
$
b Total federal tax withheld under Chapter 3 .
.
.
.
.
.
.
.
.
.
.
Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld
information shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the
instructions on page 2.
If this is your FINAL return, enter an “X” here (see instructions)
Please return this entire page to the Internal Revenue Service.
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and
belief, they are true, correct, and complete.
Sign
Here
Your signature
Title
Date
Daytime phone number
1042-T
For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.
Cat. No. 28848W
Form
(2019)
2
Form 1042-T (2019)
Page
Instructions
Forms 1042 and 1042-S. See the Instructions for Form 1042 for
the definition of withholding agent. See the Instructions for Form
Future Developments
1042-S for the withholding agent codes for the chapter 4 and 3
status codes. You must enter both a chapter 4 and a chapter 3
For the latest information about developments related to Form
withholding agent status code regardless of the type of payment
1042-T and its instructions, such as legislation enacted after
being made.
they were published, go to www.irs.gov/Form1042T.
Line 1. You must file a separate Form 1042‐T for each type of
Purpose of Form
paper Form 1042‐S you are transmitting.
Use this form to transmit paper Forms 1042-S, Foreign Person’s
Line 1a. Withholding agents are not permitted to file a single
U.S. Source Income Subject to Withholding, to the Internal
Form 1042‐T to transmit both chapter 4 and chapter 3 amounts.
Revenue Service. Use a separate Form 1042-T to transmit each
Withholding agents must indicate either chapter 4 or chapter 3
type of Form 1042-S (see the instructions for line 1 below).
to designate the chapter for which they are filing a given Form
1042‐T. The chapter you designate on this form must be the
!
Do not use Form 1042-T if you submit Forms 1042-S
same as that on all attached Forms 1042‐S. See Chapter
electronically.
indicator in the Form 1042‐S instructions for additional
information.
CAUTION
Line 1b. Check either the Original or Amended box (but not
Electronic Filing Requirement
both).
You must file Forms 1042‐S electronically if:
Line 1c. Check the box on this line 1c if you are filing pro rata
• You are required to file 250 or more Forms 1042‐S,
Forms 1042‐S (see the Form 1042‐S instructions).
• You are a financial institution (regardless of the number of
As a result of the above rules, there are eight possible types
Forms 1042‐S required to be filed), or
of Form 1042‐S that may be transmitted, and each type requires
• You are a partnership that has more than 100 partners or
a separate Form 1042‐T.
that is required to file at least 150 Forms 1042‐S.
• Chapter 4, original, pro rata.
The IRS encourages filers to transmit the forms electronically
• Chapter 4, original, non‐pro rata.
even when not required to do so.
• Chapter 4, amended, pro rata.
See the Instructions for Form 1042-S for filing requirements
• Chapter 4, amended, non‐pro rata.
for Form 1042-S and for the definition of financial institution.
• Chapter 3, original, pro rata.
Filing Forms 1042 and 1042-S
• Chapter 3, original, non‐pro rata.
Use of this form to transmit paper Forms 1042-S does not affect
• Chapter 3, amended, pro rata.
your obligation to file Form 1042, Annual Withholding Tax
• Chapter 3, amended, non‐pro rata.
Return for U.S. Source Income of Foreign Persons.
Each type must be transmitted with a separate Form 1042-T.
If you have not yet filed a Form 1042 for 2019, you may send
For example, you must transmit only Chapter 3, original, pro
in more than one Form 1042-T to submit paper Forms 1042-S
rata Forms 1042-S with one Form 1042-T.
prior to filing your Form 1042. You may submit amended Forms
Line 2. Enter the total of the gross income amounts shown on
1042-S even though changes reflect differences in gross
the Forms 1042-S (box 2) being transmitted with this Form
income and tax withheld information of Forms 1042-S
1042-T.
previously submitted with a Form 1042-T.
Line 3. Enter the total of the federal tax withheld amounts
If you have already filed a Form 1042 for 2019 and an
shown on all Forms 1042-S (total of amounts reported in boxes
attached Form 1042-S caused the gross income or tax withheld
10 and 11) being transmitted with this Form 1042-T. On this
information previously reported on line 62c or 63e of your Form
Form 1042-T, complete either line 3a or line 3b, but not both. If
1042 to change, you must file an amended Form 1042.
you indicated “Chapter 4” on line 1a, complete line 3a to report
Where and When To File
the total amounts withheld pursuant to chapter 4. If you
indicated “Chapter 3” on line 1a, complete line 3b to report the
File Form 1042-T (and Copy A of the paper Forms 1042-S being
total amounts withheld pursuant to chapter 3.
transmitted) with the Ogden Service Center, P.O. Box 409101,
Ogden, UT 84409, by March 16, 2020. Send the forms in a flat
Final return. If you will not be required to file additional Forms
mailing (not folded).
1042-S, including amended Forms 1042-S for the 2019 year (on
paper or electronically), enter an “X” in the “FINAL return” box.
Line Instructions
Paperwork Reduction Act Notice. The time needed to
Identifying information at top of form. The name, address,
complete and file this form will vary depending on individual
EIN, and chapter 4 and 3 status codes of the withholding agent
circumstances. The estimated average time is 12 minutes.
named on this form must be the same as those you enter on
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