Clear form
                                                                                             Utah State Tax Commission                                   2021
40101                                                                     Utah Individual Income Tax Return
                                                                                                                                                         TC-40
                                                                                  All State Income Tax Dollars Fund Education
9998
                                                                                          •  Amended Return - enter code:      (see instructions)
USTC ORIGINAL FORM                                                                                                                                       Full-yr Resident?
  Your Social Security No.           Your first name                      Your last name                                                                       Y/N

  Spouse’s Soc. Sec. No.             Spouse’s first name                  Spouse's last name

                                     Address                                                                              Telephone number
  
   If deceased, complete
                                     City                                           State      ZIP+4                      Foreign country (if not U.S.)
         page 3, Part 1

1   Filing Status - enter code                          • 2  Qualifying Dependents                             3  Election Campaign Fund
          1 = Single                                       a         Dependents age 16 and under                     Does not increase your tax or reduce your refund.
•         2 = Married filing jointly                       b         Other dependents                           Enter the code for the      Yourself          Spouse
          3 = Married filing separately                    c         Total (add lines a and b)                  party of your choice.      •                 •
          4 = Head of household                                                                                   See instructions for   
          5 = Qualifying widow(er)                         Dependents must be claimed for the child tax           code letters or go to incometax.utah.gov/elect.
If using code 2 or 3, enter spouse’s name and SSN above    credit on your federal return. See instructions.  If no contribution, enter N. 

4  Federal adjusted gross income from federal return                                                                              •  4                                .00

5  Additions to income from TC-40A, Part 1 (attach TC-40A, page 1)                                                                •  5                                .00

6  Total income - add line 4 and line 5                                                                                                6                              .00

7  State tax refund included on federal form 1040, Schedule 1, line 1 (if any)                                                    •  7                                .00

8  Subtractions from income from TC-40A, Part 2 (attach TC-40A, page 1)                                                           •  8                                .00

9  Utah taxable income (loss) - subtract the sum of lines 7 and 8 from line 6                                                     •  9                                .00

10 Utah tax - multiply line 9 by 4.95% (.0495) (not less than zero)                                                               • 10                                .00

11  Utah personal exemption (multiply line 2c by $1,750)                                       • 11                         .00
                                                                                                                                          Electronic filing
12  Federal standard or itemized deductions                                                    • 12                         .00           is quick, easy and
                                                                                                                                              free, and will
13  Add line 11 and line 12                                                                      13                         .00         speed up your refund.

14  State income tax included in federal itemized deductions                                   • 14                         .00           To learn more, 
                                                                                                                                                        go to
15  Subtract line 14 from line 13                                                                15                         .00               tap.utah.gov

16  Initial credit before phase-out - multiply line 15 by 6% (.06)                             • 16                         .00

17 Enter:     $15,095 (if single or married filing separately); $22,643 (if head               • 17                         .00
              of household); or $30,190 (if married filing jointly or qualifying widower)
18  Income subject to phase-out - subtract line 17 from line 9 (not less than zero)              18                         .00

19  Phase-out amount - multiply line 18 by 1.3% (.013)                                         • 19                         .00

20  Taxpayer tax credit - subtract line 19 from line 16 (not less than zero)                                                      • 20                                .00

21  If you are a qualified exempt taxpayer, enter “X” (complete worksheet in instr.)           • 21

22 Utah income tax - subtract line 20 from line 10 (not less than zero)                                                           •  22                               .00

              Utah Individual Income Tax Return (continued)                                                                TC-40                              Pg. 2
40102         SSN                                        Last name                                                         2021
USTC ORIGINAL FORM
  23  Enter tax from TC-40, page 1, line 22                                                                                  23                                          .00

  24  Apportionable nonrefundable credits from TC-40A, Part 3 (attach TC-40A, page 1)                                      •  24                                         .00

  25  Full-year resident, subtract line 24 from line 23 (not less than zero)                                               •  25                                         .00
    Non or Part-year resident, complete and enter the UTAH TAX from TC-40B, line 41
  26  Nonapportionable nonrefundable credits from TC-40A, Part 4 (attach TC-40A, page 1)                                   •  26                                         .00

  27  Subtract line 26 from line 25 (not less than zero)                                                                     27                                          .00

  28  Voluntary contributions from TC-40, page 3, Part 4 (attach TC-40, page 3)                                            •  28                                         .00

  29  AMENDED RETURN ONLY - previous refund                                                                                •  29                                         .00

  30  Recapture of low-income housing credit                                                                               •  30                                         .00

  31  Utah use tax                                                                                                         •  31                                         .00

 32 Total tax, use tax and additions to tax (add lines 27 through 31)                                                        32                                          .00

  33  Utah income tax withheld shown on TC-40W, Part 1 (attach TC-40W, page 1)                                             •  33                                         .00

  34  Credit for Utah income taxes prepaid from TC-546 and 2020 refund applied to 2021                                     •  34                                         .00

  35  Pass-through entity withholding tax shown on TC-40W, Part 3 (attach TC-40W, page 2)                                  •  35                                         .00

  36  Mineral production withholding tax shown on TC-40W, Part 2 (attach TC-40W, page 2)                                   •  36                                         .00

  37  AMENDED RETURN ONLY - previous payments                                                                              •  37                                         .00

  38  Refundable credits from TC-40A, Part 5 (attach TC-40A, page 2)                                                       •  38                                         .00

  39  Total withholding and refundable credits - add lines 33 through 38                                                     39                                          .00

 40 TAX DUE - subtract line 39 from line 32 (not less than zero)                                                           •  40                                         .00
  41  Penalty and interest (see instructions)                                         41                                .00
 42 TOTAL DUE - PAY THIS AMOUNT - add line 40 and line 41                                                                  •  42                                         .00

 43 REFUND - subtract line 32 from line 39 (not less than zero)                                                            •  43                                         .00

  44  Voluntary subtractions from refund (not greater than line 43)                                                        •  44                                         .00
    Enter the total from page 3, Part 5
 45 DIRECT DEPOSIT YOUR REMAINING REFUND - provide account information (see instructions for foreign accounts)                                      checking  savings
    •  Routing number                          •  Account number                                                        Account type:  •                     •

Under penalties of perjury, I declare to the best of my knowledge and belief, this return and accompanying schedules are true, correct and complete.
  SIGN  Your signature                                   Date                   Spouse’s signature (if filing jointly)                              Date
 HERE
  Third Party Name of designee (if any) you authorize to discuss this return          Designee’s telephone number          Designee PIN
   Designee                                                                                                                •
              Preparer’s signature                       Date                         Preparer’s telephone number          Preparer’s PTIN
      Paid                                                                                                                 •
  Preparer’s  Firm’s name                                                                                                  Preparer’s EIN
   Section    and address                                                                                                  •

Attach TC-40 page 3 if you: are filing for a deceased taxpayer, are filing a fiscal year return, filed IRS form 8886, are making voluntary contributions, want to deposit into a 
my529 account, want to apply all/part of your refund to next year’s taxes, want to direct deposit to a foreign account, or no longer qualify for a homeowner’s exemption.

          Utah Individual Income Tax Return (continued)                                                                 TC-40              Pg. 3
40103     SSN                                      Last name                                                            2021
USTC ORIGINAL FORM

 Part 1 - Deceased Taxpayer Information
   If the taxpayer shown on page 1 is deceased, enter the date of death here:                                                 •  /        /
                                                                                                                                 mm/dd/yy
   If the spouse shown on page 1 is deceased, enter the date of death here:                                                   •  /        /
                                                                                                                                 mm/dd/yy
   If you are claiming a refund for a deceased taxpayer and are not the surviving spouse, enter “X”:                          •
     You must complete and attach form TC-131 to the return. 

   Part 2 - Fiscal Year Filer
   If filing a fiscal year return (a year other than January 1 through December 31), enter the fiscal year end (mm/yy)        •     /
     See instructions.                                                                                                           mm/yy

   Part 3 - Federal Form 8886 filed
   If you filed federal form 8886, Reportable Transaction Disclosure Statement, enter “X”:                                    •
     Get form and instructions at irs.gov.

   Part 4 - Voluntary Contributions (write the code and amount of each voluntary contribution)                                         
   See explanation of each contribution at incometax.utah.gov/contributions and/or the TC-40 instructions
                                                                                                                                       Sch Dist
   02  Pamela Atkinson Homeless Account                                                                Code            Amount          Code
   03  Kurt Oscarson Children’s Organ Transplant Account 
   05  School District and Nonprofit School District Foundation - enter school district code         •                           .00
        See instructions for school district codes, or get codes at
   incometax.utah.gov/contributions/school-districts                                                 •                           .00
   15 Clean Air Fund
   16  Governor’s Suicide Prevention Fund                                                            •                           .00
  
                                                                                                     •                           .00

   Total voluntary contributions (enter the total here and on TC-40, page 2, line 28):                                           .00

   Part 5 - Voluntary Subtractions from Refund
   1. Enter the amount of your refund you want deposited into your my529 account(s):                                    • 1                .00
         See instructions. Also see my529.org, or call 1-800-418-2551. 
   2. Enter the amount of your refund you want applied to your 2022 taxes:                                              • 2                .00

   Total voluntary subtractions (enter the total here and on TC-40, page 2, line 44):                                                      .00
     May not be greater than the amount on line 43.

  Part 6 - Direct Deposit to Foreign Account
   If you choose to direct deposit your refund to an account outside the United States and its territories, enter “X”:        •
     The Tax Commission cannot transfer a refund to an account outside the United States and its territories.
     By checking this box, your refund will not be direct deposited but will be sent to you by check.

  Part 7 - Property Owner’s Residential Exemption Termination Declaration
   If you are a Utah residential property owner and declare you no longer qualify to receive a residential exemption          •     Enter “X”
   authorized under UC §59-2-103 for your primary residence, enter “X” and enter the county code where the
   residence is located (see instructions or incometax.utah.gov for county codes and additional information).                 •     Enter code

   Mail                            Utah State Tax Commission               Mail                               Utah State Tax Commission
   RETURNS WITH                    210 N 1950 W                            ALL OTHER                          210 N 1950 W
   PAYMENTS to:  Ź           ŹSalt Lake City, UT 84134-0266                RETURNS to:                        Salt Lake City, UT 84134-0260

                                                         Submit page ONLY if data entered.
                                              Attach completed schedule to your Utah Income Tax return.

         Income Tax Supplemental Schedule                                                                          TC-40A    Pg. 1
40104    SSN                                          Last name                                                    2021
USTC ORIGINAL FORM

Part 1 - Additions to Income (enter the code and amount of each addition to income)                             Code   Amount
  See instructions or incometax.utah.gov for codes.                                                •                         .00

                                                                                                   •                         .00

                                                                                                   •                         .00
                                                       
                                                                                                   •                         .00

                                                                                                   •                         .00

  Total additions to income(add all additions to income and enter total here and on TC-40, line 5)                           .00

Part 2 - Subtractions from Income (enter the code and amount of each subtraction from income)                   Code   Amount
  See instructions or incometax.utah.gov for codes.                                                •                         .00

  If using subtraction 77 (Native American Income), enter your enrollment                          •                         .00
  number and tribal code:               Tribe
              Enrollment Number         Code                                                       •                         .00
  You        •  
  Spouse     •                                                                                     •                         .00
               
                                                                                                   •                         .00
                                                       
  Total subtractions from income (add all subtractions from income and enter total here and on TC-40, line 8)                .00

Part 3 - Apportionable Nonrefundable Credits (enter the code and amount of each credit)                         Code   Amount
  See instructions or incometax.utah.gov for codes.                                                •                         .00

                                                                                                   •                         .00
  If you are using credit 18 (Retirement Credit), enter your birth date(s):
  You    •       /  /                   Spouse    • /  /                                           •                         .00
                mm/dd/yy                             mm/dd/yy
                                                                                                   •                         .00
                       
                                                                                                   •                         .00

  Total apportionable nonrefundable credits (add all Part 3 credits and enter total here and on TC-40, line 24)              .00

Part 4 - Nonapportionable Nonrefundable Credits (enter the code and amount of each credit)                      Code   Amount
  See instructions or incometax.utah.gov for codes.                                                •                         .00

                                                                                                   •                         .00

  If you are using credit 02 (Qualified Sheltered Workshop),                                       •    .00
    enter the sheltered workshop’s name:                        
                                                                                                   •                         .00
                                                                
                                                                                                   •                         .00
                                         
  Total nonapportionable nonrefundable credits (add all Part 4 credits and enter total here and on TC-40, line 26)           .00

                                                     Submit page ONLY if data entered.
                                         Attach completed schedule to your Utah Income Tax Return.

      Income Tax Supplemental Schedule                                                             TC-40A     Pg. 2
40105 SSN                                            Last name                                     2021
USTC ORIGINAL FORM

Part 5 - Refundable Credits (enter the code and amount of each refundable credit)                  Code Amount
  See instructions or incometax.utah.gov for codes.                                              •            .00

                                                                                                 •            .00

                                                                                                 •            .00

                                                                                                 •            .00

                                                                                                 •            .00

Total refundable credits (add all refundable credits and enter total here and on TC-40, line 38)              .00

                                                     Submit page ONLY if data entered.
                                        Attach completed schedule to your Utah Income Tax Return.

          Non and Part-year Resident Schedule                                                                                TC-40B
40106     SSN                                           Last name                                                            2021
USTC ORIGINAL FORM
Residency Status:      •   Nonresident: Home state abbreviation:         •                   Part-year resident from: /  /     to  /  /
                                                                                                                      mm/dd/yy     mm/dd/yy

Income                                                                                         Col. A - UTAH                   Col. B - TOTAL
1  Wages, salaries, tips, etc. (1040 line 1)                                                                    .00                    .00
2  Taxable interest income (1040 line 2b)                                                                       .00                    .00
3  Ordinary dividends (1040 line 3b)                                                                            .00                    .00
4  IRAs, pensions and annuities - taxable amount (1040 lines 4b and 5b)                                         .00                    .00
5  Social Security benefits - taxable amount (1040 line 6b)                                                     .00                    .00
6  Taxable refunds/credits/offsets of state/local income taxes (1040, Schedule 1, line 1)                       .00                    .00
7  Alimony received (1040, Schedule 1, line 2a)                                                                 .00                    .00
8  Business income or (loss) (1040, Schedule 1, line 3)                                                         .00                    .00
9  Capital gain or (loss) (1040, line 7)                                                                        .00                    .00
10 Other gains or (losses) (1040, Schedule 1, line 4)                                                           .00                    .00
11 Rental real estate, royalties, partnerships, S corps, trusts, etc. (1040, Schd 1, line 5)                    .00                    .00
12 Farm income or (loss) (1040, Schedule 1, line 6)                                                             .00                    .00
13 Unemployment compensation (1040, Schedule 1, line 7)                                                         .00                    .00
14 Other income (1040, Schedule 1, line 9)                                                                      .00                    .00
15 Additions to income from TC-40A, Part 1 (Utah portion only in Utah column)                                   .00                    .00
16 Reserved                                                                                                     .00                    .00
17 Reserved                                                                                                     .00                    .00
18 Total income (loss) - add lines 1 through 17 for both columns A and B                                        .00                    .00

Adjustments                                                                                    Col. A - UTAH                   Col. B - TOTAL
19 Educator expenses (1040, Schedule 1, line 11)                                                                .00                    .00
20 Certain bus. expenses of reservists, performing artists, etc. (1040, Schd 1, line 12)                        .00                    .00
21 Health savings account deduction (1040, Schedule 1, line 13)                                                 .00                    .00
22 Moving expenses (1040, Schedule 1, line 14) - col. A only expenses moving into Utah                          .00                    .00
23 Deductible part of self-employment tax (1040, Schedule 1, line 15)                                           .00                    .00
24 Self-employed SEP, SIMPLE and qualified plans (1040, Schedule 1, line 16)                                    .00                    .00
25 Self-employed health insurance deduction (1040, Schedule 1, line 17)                                         .00                    .00
26 Penalty on early withdrawal of savings (1040, Schedule 1, line 18)                                           .00                    .00
27 Alimony paid (1040, Schedule 1, line 19a)                                                                    .00                    .00
28 IRA deduction (1040, Schedule 1, line 20)                                                                    .00                    .00
29 Student loan interest deduction (1040, Schedule 1, line 21)                                                  .00                    .00
30 Reserved                                                                                                     .00                    .00
31 Reserved                                                                                                     .00                    .00
32 Taxable refunds/credits/offsets of state and local income taxes (1040, Schd 1, line 1)                       .00                    .00
33 Subtractions from income from TC-40A, Part 2 (Utah portion only in Utah column)                              .00                    .00
34 Reserved                                                                                                     .00                    .00
35 Reserved                                                                                                     .00                    .00
36 (see instructions):                                                                                          .00                    .00
37 Total adjustments - add lines 19 through 36 for both columns A and B                                         .00                    .00

38 Subtract line 37 from line 18 for both columns A and B                                    •                  .00      •             .00
   Line 38, column B must equal TC-40, line 9

Non or Part-year Resident Utah Tax
39 Divide line 38 column A by line 38 column B (to 4 decimal places, not more than 1.0000 or less than 0.0000)    39
                                                                                                                  
40 Subtract TC-40, line 24 from TC-40, line 23 and enter the result (not less than zero) here                            40            .00

41 UTAH TAX - Multiply line 40 by the decimal on line 39. Enter on TC-40, page 2, line 25                              •  41           .00

                                                   Submit this page ONLY if data entered.
                                         Attach completed schedule to your Utah Income Tax Return.

      Credit for Income Tax Paid to Another State                                                                       TC-40S
40108 SSN                                                     Last name                                                 2021

NOTE: Part-year residents rarely qualify for this credit. Nonresidents do not qualify for this credit. See instructions.
FIRST STATE
  1  Enter federal adjusted gross income taxed by both Utah and state of:                      1    .00

  2  Federal adjusted gross income from TC-40, line 4 (see instructions)                       2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.                     3

  4  Utah income tax from TC-40, line 22. Part-year residents, see instructions.               4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual income tax paid to state shown on line 1                                           6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                                     7     .00

SECOND STATE
  1  Enter federal adjusted gross income taxed by both Utah and state of:                      1    .00

  2  Federal adjusted gross income from TC-40, line 4 (see instructions)                       2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.                     3

  4  Utah income tax from TC-40, line 22. Part-year residents, see instructions.               4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual income tax paid to state shown on line 1                                           6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                                     7     .00

THIRD STATE
  1  Enter federal adjusted gross income taxed by both Utah and state of:                      1    .00

  2  Federal adjusted gross income from TC-40, line 4 (see instructions)                       2    .00

  3  Divide line 1 by line 2; round to 4 decimal places. Do not enter a number greater than 1.0000.                     3

  4  Utah income tax from TC-40, line 22. Part-year residents, see instructions.               4    .00

  5  Credit limitation - multiply line 4 by decimal on line 3                                  5    .00

  6  Actual income tax paid to state shown on line 1                                           6    .00
     Part-year residents must prorate tax paid to other state. Credit only applies
     to the portion of actual taxes paid to the other state on income shown on line 1.

  7  Credit for tax paid another state - lesser of line 5 or line 6                                                     7     .00

            Use additional forms TC-40S if claiming credits for more than three states.
            Enter the total of all amounts shown on line 7 above on TC-40A, Part 4, using code 17.
                                                              Submit page ONLY if data entered.
            Attach completed schedule to your Utah Income Tax Return.

      Part 1 - Utah Withholding Tax Schedule                                                                   TC-40W                 Pg. 1
40109 SSN                                             Last name                                                2021
USTC ORIGINAL FORM

   Line Explanations                                              IMPORTANT

    1  Employer/payer ID number from W-2 box “b” or 1099          Do not send your W-2s or 1099s with your return. Instead enter
    2  Utah withholding ID number from W-2 box “15” or 1099       W-2 or 1099 information below, but only if there is Utah withholding
     (14 characters, ending in WTH, no hyphens)                   on the form.
    3  Employer/payer name and address from W-2 box “c” or 1099
    4  Enter “X” if reporting Utah withholding from form 1099     Use additional forms TC-40W if you have more than four W-2s and/or
    5  Employee’s Social Security number from W-2 box “a” or 1099 1099s with Utah withholding tax.
    6  Utah wages or income from W-2 box “16” or 1099
    7  Utah withholding tax from W-2 box “17” or 1099             Enter mineral production withholding from TC-675R in Part 2 of TC-40W;
                                                                  enter pass-through entity withholding in Part 3 of TC-40W.

First W-2 or 1099                                                 Second W-2 or 1099
 1                                                                1

  2                      (14 characters, no hyphens)              2                                       (14 characters, no hyphens)

 3                                                                3

 4                                                                4

 5                                                                5

 6                   .00                                          6                    .00

 7                   .00                                          7                    .00

 Third W-2 or 1099                                                Fourth W-2 or 1099
 1                                                                1

  2                      (14 characters, no hyphens)              2                                       (14 characters, no hyphens)

 3                                                                3

 4                                                                4

 5                                                                5

 6                   .00                                          6                    .00

 7                   .00                                          7                    .00

                         Enter total Utah withholding tax from all lines 7 here and on TC-40, page 2, line 33:                        .00

                                                      Submit page ONLY if data entered.
                         Attach completed schedule to your Utah Income Tax Return.
                         Do not attach W-2s or 1099s to your Utah return.

      Mineral Production and Pass-through Withholding                                                     TC-40W Pg. 2
40110 SSN                                              Last name                                          2021
USTC ORIGINAL FORM
Part 2 -Utah Mineral Production Withholding Tax - TC-675R
  Do not send TC-675R or Utah Schedules K-1 with return. Enter TC-675R or Schedule K-1 information below. Use additional TC-40Ws if needed.
   Line Explanations
    1  Producer’s EIN from box “2” of TC-675R                     4  Pass-through entity EIN if credit from partnership or S corporation
    2  Producer’s name from box “1” of TC-675R                      (enter EIN from Utah Schedule K-1)
    3  Producer’s Utah withholding number from box “3” of TC-675R 5  Utah mineral production withholding tax from box”6” of TC-675R or
     (14 characters, ending in WMP, no hyphens)                     from Utah Schedule K-1.
  First TC-675R or Utah Schedule K-1                              Second TC-675R or Utah Schedule K-1
 1                                                                1

 2                                                                2

  3                                  (14 characters, no hyphens)  3                                       (14 characters, no hyphens)

 4                                                                4

 5                      .00                                       5                     .00

Third TC-675R or Utah Schedule K-1                                Fourth TC-675R or Utah Schedule K-1
 1                                                                1

 2                                                                2

  3                                  (14 characters, no hyphens)  3                                       (14 characters, no hyphens)

 4                                                                4

 5                      .00                                       5                     .00

      Enter total mineral production withholding tax from all lines 5 here and on TC-40, page 2, line 36.                                  .00

Part 3 -Utah Pass-through Entity Taxpayer Withholding - Utah Schedule K-1
  Do not send Utah Schedule(s) K-1 with return. Enter information below. Use additional TC-40Ws if needed.
   Line Explanations
    1  Pass-through entity EIN from Utah Schedule K-1 box “A”
    2  Name of pass-through entity from Utah Schedule K-1 box “B”
    3  Utah withholding tax paid by pass-through entity
First Utah Schedule K-1                                           Second Utah Schedule K-1
 1                                                                1

 2                                                                2

 3                      .00                                       3                     .00

Third Utah Schedule K-1                                           Fourth Utah Schedule K-1
 1                                                                1

 2                                                                2

 3                      .00                                       3                     .00

      Enter total pass-through withholding tax from all lines 3 here and on TC-40, page 2, line 35:                                        .00

                                                       Submit page ONLY if data entered.
                                     Attach completed schedule to your Utah Income Tax Return.