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Nebraska Fiduciary Income Tax Return FORM 1041N
for the taxable year January 1, 2022 through December 31, 2022 or other taxable year
beginning , 2022 and ending , 20 2022
Name of Estate or Trust PLEASE DO NOT WRITE IN THIS SPACE
Name and Title of Fiduciary
Street or Other Mailing Address of Fiduciary
City State Zip Code
Nebraska ID Number Federal ID Number Type of Trust (If Grantor Type, See Instructions)
Please Type or Print Testamentary Inter Vivos Grantor Type
Status of Estate or Trust Type of Return
(1) Resident (2) Nonresident Estate Simple Trust Complex Trust ESBT Bankruptcy Estate Amended Return
Check applicable boxes:
(1) Initial Nebraska Return (2) Final Return (3) Change in Address (4) 7004 Attached (5) Distributed Form 3800N Credit
Does the estate or trust have nonresident individual beneficiaries? Is the trust a pooled income fund?
YES (Complete Schedule II) NO YES NO
1 Total federal income ....................................................................... 1 00
2 Federal taxable income..................................................................... 2 00
3 Undistributed income from U.S. government bonds or other U.S. obligations ........................... 3 00
4 Undistributed income from non-Nebraska state and local bond interest and other Nebraska adjustments
increasing federal taxable income (attach a schedule) (see instructions)............................... 4 00
5 Special Capital Gains/Extraordinary Dividend Deduction .......................................... 5 00
6 Nebraska adjustments decreasing federal taxable income (attach a schedule) (see instructions)............ 6 00
7 Nebraska taxable income (line 2 plus line 4) minus (lines 3, 5, and 6) ................................ 7 00
Nonresident estates and trusts should not make entries on lines 8 through 10.
Instead, Nonresident estates and trusts must complete Nebraska Schedule I to determine the line 11 entry.
8 Nebraska income tax (use the tax rate schedule on page 8 of instructions)............................. 8 00
9 Nebraska other tax (Federal Form 4972) (see instructions) ......................................... 9 00
10 Electing Small Business Trust (ESBT) Nebraska Tax (complete ESBT Worksheet) ...................... 10 00
11 Total Nebraska tax (total of lines 8, 9, and 10) ................................................... 11 00
12 Credit for tax paid by resident estate or trust to other states (Schedule III) ...... 12 00
13 Community Development Assistance Act credit and Financial Institution Tax credit 13 00
14 Form 3800N nonrefundable credit (attach Form 3800N) ..................... 14 00
15 Employer’s credit for expenses incurred for TANF (ADC) recipients (see instr.) ... 15 00
16 Total nonrefundable credits (total of lines 12 through 15)........................................... 16 00
17 Nebr. income tax after nonrefundable credits. Subtract line 16 from line 11 (if line 16 is greater than line 11, enter zero -0-) 17 00
18 Nebraska income tax withholding for nonresident individual beneficiaries [total of column (G), Schedule II] ... 18 00
19 Total Nebraska income tax liability (line 17 plus 18) ............................................... 19 00
20 Form 3800N refundable credit (attach Form 3800N) ........................ 20 00
21 Tax deposited with Form 7004N and 2022 estimated income tax payments ...... 21 00
22 Beginning Farmer credit (attach certificate) ............................... 22 00
23 Credit for school district property taxes (attach Form PTC) ................... 23 00
24 Credit for community college property taxes (attach Form PTC) ............... 24 00
25 Other credits (attach Nebraska copy of Federal Forms W-2, 1099-R, or W-2G) ... 25 00
26 Total payments (total of lines 20 through 25) .................................................... 26 00
27 TAX DUE (if line 19 is greater than line 26, subtract line 26 from line 19) .......................... 27 00
28 OVERPAYMENT (if line 26 is greater than line 19, subtract line 19 from line 26) ........................ 28 00
29 Overpayment on line 28 you want credited to 2023 estimated income tax .......................... 29 00
30 Overpayment to be REFUNDED (line 28 minus line 29)............................................ 30 00
Under penalties of perjury, I declare that as taxpayer or preparer, I have examined this return, including accompanying schedules and statements,
and to the best of my knowledge and belief, it is correct and complete.
sign
Signature of Fiduciary or Officer Representing Fiduciary Date Email Address
here ( )
paid Title Phone Number
preparer’s Preparer’s Signature Date Preparer’s PTIN
use only ( )
Firm’s Name (or yours if self-employed), Address and Zip Code EIN Daytime Phone
A copy of the federal return and schedules must be attached to this return.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818. 8-424-2022
