DO NOT STAPLE
                                                                                                                        OMB No. 1545-0096
Form 1042-T                          Annual Summary and Transmittal of  
                                                      Forms 1042-S
Department of the Treasury                                                                                              2022
Internal Revenue Service                      Go to www.irs.gov/Form1042T for the latest information.
Name of withholding agent                                                                Ch. 4 Status Code      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 

e    Check if you are a partnership reporting withholding that occurred in the subsequent year (see instructions) 

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

For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.           Cat. No. 28848W Form 1042-T (2022)

Form 1042-T (2022)                                                                                                            Page 2 
Instructions                                                        Line 1b. Check either the Original or Amended box (but not 
                                                                  both).
Future Developments                                                 Line 1c. Check the box on this line 1c if you are filing pro rata 
For the latest information about developments related to Form     Forms 1042‐ S (see the Form 1042‐S instructions).
1042-T and its instructions, such as legislation enacted after      Line 1e. Check the box on line 1e if you are a partnership 
they were published, go to www.irs.gov/Form1042T.                 reporting withholding that occurred in the subsequent year with 
                                                                  respect to a foreign partner’s share of undistributed income for 
Purpose of Form                                                   the prior year. The attached Form(s) 1042-S should have the 
Use this form to transmit paper Forms 1042-S, Foreign Person’s    checkbox checked in box 7c.
U.S. Source Income Subject to Withholding, to the Internal          As a result of the above rules, there are sixteen possible types 
Revenue Service. Use a separate Form 1042-T to transmit each      of Form 1042‐S that may be transmitted, and each type requires 
type of Form 1042-S (see the instructions for line 1 below).      a separate Form 1042‐T.
          Do not use Form 1042-T if you submit Forms 1042-S         • Chapter 4, original, pro rata.
          electronically. See the instructions for Form 1042-S      • Chapter 4, original, non‐pro rata.
CAUTION
▲!        for the electronic filing requirements for Form 1042-S.   • Chapter 4, amended, pro rata.
Filing Forms 1042 and 1042-S                                        • Chapter 4, amended, non‐pro rata.
                                                                    • Chapter 4, original, pro rata, partnership.
Use of this form to transmit paper Forms 1042-S does not affect 
your obligation to file Form 1042, Annual Withholding Tax           • Chapter 4, original, non-pro rata, partnership.
Return for U.S. Source Income of Foreign Persons.                   • Chapter 4, amended, pro rata, partnership.
If you have not yet filed a Form 1042 for 2022, you may send        • Chapter 4, amended, non-pro rata, partnership.
in more than one Form 1042-T to submit paper Forms 1042-S           • Chapter 3, original, pro rata.
prior to filing your Form 1042. You may submit amended Forms        • Chapter 3, original, non‐pro rata.
1042-S even though changes reflect differences in gross 
income and tax withheld information of Forms 1042-S                 • Chapter 3, amended, pro rata.
previously submitted with a Form 1042-T.                            • Chapter 3, amended, non‐pro rata.
If you have already filed a Form 1042 for 2022 and an               • Chapter 3, original, pro rata, partnership.
attached Form 1042-S caused the gross income or tax withheld        • Chapter 3, original, non-pro rata, partnership.
information previously reported on line 62c or 63e of your Form     • Chapter 3, amended, pro rata, partnership.
1042 to change, you must file an amended Form 1042.
                                                                    • Chapter 3, amended, non-pro rata, partnership.
Where and When To File                                              Each type must be transmitted with a separate Form 1042-T. 
File Form 1042-T (and Copy A of the paper Forms 1042-S being      For example, you must transmit only Chapter 3, original, pro 
transmitted) with the Ogden Service Center, P.O. Box 409101,      rata Forms 1042-S with one Form 1042-T.
Ogden, UT 84409, by March 15, 2023. Send the forms in a flat      Line 2. Enter the total of the gross income amounts shown on 
mailing (not folded).                                             the Forms 1042-S (box 2) being transmitted with this Form 
                                                                  1042-T.
Line Instructions
                                                                  Line 3. Enter the total of the federal tax withheld amounts 
Identifying information at top of form. The name, address,        shown on all Forms 1042-S (total of amounts reported in boxes 
EIN, and chapter 4 and chapter 3 status codes of the              10 and 11) being transmitted with this Form 1042-T. On this 
withholding agent named on this form must be the same as          Form 1042-T, complete either line 3a or line 3b, but not both. If 
those you enter on Forms 1042 and 1042-S. See the                 you indicated “Chapter 4” on line 1a, complete line 3a to report 
Instructions for Form 1042 for the definition of withholding      the total amounts withheld pursuant to chapter 4. If you 
agent. See the Instructions for Form 1042-S for the withholding   indicated “Chapter 3” on line 1a, complete line 3b to report the 
agent codes for the chapter 4 and chapter 3 status codes. You     total amounts withheld pursuant to chapter 3. 
must enter both a chapter 4 and a chapter 3 withholding agent 
status code regardless of the type of payment being made.         Final return. If you will not be required to file additional Forms 
                                                                  1042-S, including amended Forms 1042-S for the 2022 year (on 
Line 1. You must file a separate Form 1042‐ T for each type of    paper or electronically), enter an “X” in the FINAL return box.
paper Form 1042‐ S you are transmitting.                          Paperwork Reduction Act Notice.The time needed to 
Line 1a. Withholding agents are not permitted to file a single    complete and file this form will vary depending on individual 
Form 1042‐ T to transmit both chapter 4 and chapter 3 amounts.    circumstances. The estimated average time is 12 minutes.
Withholding agents must indicate either chapter 4 or chapter 3 
to designate the chapter for which they are filing a given Form 
1042‐T. The chapter you designate on this form must be the 
same as that on all attached Forms 1042‐ S. See Chapter 
indicator in the Form 1042‐S instructions for additional 
information.