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Federal housing law

Form 1042 — Annual Withholding Tax Return for U.S. Source Income of Foreign Persons

Federal housing law as enacted — verbatim and citable.

Edition
2026-10-03
Last updated
2026-10-04
Jurisdiction
United States
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Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1042.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Form

1042

Department of the Treasury Internal Revenue Service

Exceptions & meaning →

Annual Withholding Tax Return for U.S. Source Income of Foreign Persons

Go to www.irs.gov/Form1042 for instructions and the latest information.

Exceptions & meaning →

2025

OMB No. 1545-0096

If this is an amended return, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of withholding agent Employer identification number

For IRS Use Only

Ch. 3 Status Code Ch. 4 Status Code CC FD Number and street (If a P.O. box, see instructions.) Room or suite no. RD FF

CAF FP

City or town State or province Country ZIP or foreign postal code CR I

EDC SIC

If you do not expect to file this return in the future, check here Enter date final income paid Section 1 Record of Federal Tax Liability (do not show federal tax deposits here)

Ch. 3 Status Code Ch. 4 Status Code Number and street (If a P.O. box, see instructions.) Room or suite no.

City or town State or province Country ZIP or foreign postal code

CC RD CAF CR EDC

Line
No.		 Period
ending		 Tax liability for period
(including any taxes assumed
on Form(s) 1000)		 Line
No.		 Period
ending		 Tax liability for period
(including any taxes assumed
on Form(s) 1000)		 Line
No.		 Period
ending		 Tax liability for period
(including any taxes assumed
on Form(s) 1000)
1
Jan.



 7
15
22
31		 21
May



 7
15
22
31		 41
Sept.



 7
15
22
30
2
2
2
22
22
22
42
42
42
3
3
3
23
23
23
43
43
43
4 4 4 24 24 24 44 44 44
5
 Jan. total
 Jan. total
 25
 May total
 May total
 45
Sept. total
 Sept. total
6
Feb.



 7
15
22
28		 26
June



 7
15
22
30		 46
Oct.



 7
15
22
31
7
7
7
27
27
27
47
47
47
8
8
8
28
28
28
48
48
48
9 9 9 29 29 29 49 49 49
10
 Feb. total
 Feb. total
 30
 June total
 June total
 50
 Oct. total
 Oct. total
11
Mar.



 7
15
22
31		 31
July



 7
15
22
31		 51
Nov.



 7
15
22
30
12
12
12
32
32
32
52
52
52
13
13
13
33
33
33
53
53
53
14 14 14 34 34 34 54 54 54
15
 Mar. total
 Mar. total
 35
 July total
 July total
 55
 Nov. total
 Nov. total
16
Apr.



 7
15
22
30		 36
Aug.



 7
15
22
31		 56
Dec.



 7
15
22
31
17
17
17
37
37
37
57
57
57
18
18
18
38
38
38
58
58
58
19 19 19 39 39 39 59 59 59
20 Apr. total Apr. total 40 Aug. total Aug. total 60 Dec. total Dec. total

Note: The totals from the above table are to be entered on lines 64b through 64d (as indicated in the instructions for those lines).

61 No. of Forms 1042-S filed: a On paper b Electronically

62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . .
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
c Total gross amounts reported (add lines 62a–b) . . . . . . . . . . . . . . . . .
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . .		 62a
62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
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.
d
Enter gross amounts actually paid if different from gross amounts reported .
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.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
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.
d
Enter gross amounts actually paid if different from gross amounts reported .
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.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
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.
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.
d
Enter gross amounts actually paid if different from gross amounts reported .
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.
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.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
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.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
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.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
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.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
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.
.
.
.
.
.
 62b(1)
62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . .
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
c Total gross amounts reported (add lines 62a–b) . . . . . . . . . . . . . . . . .
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . .		 62a
62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
.
.
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.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
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.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
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.
.
.
.
.
.
 62b(2)
62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . .
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
c Total gross amounts reported (add lines 62a–b) . . . . . . . . . . . . . . . . .
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . .		 62a
62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
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.
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.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62c
62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . .
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
c Total gross amounts reported (add lines 62a–b) . . . . . . . . . . . . . . . . .
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . .		 62a
62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
d
Enter gross amounts actually paid if different from gross amounts reported .
.
.
.
.
.
.
.
.
 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
.
.
.
c
Total gross amounts reported(add lines 62a–b)
.
.
.
.
.
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d
Enter gross amounts actually paid if different from gross amounts reported .
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 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
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b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
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(2)**Total U.S. source substitute payments reported other than substitute dividend payments
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c
Total gross amounts reported(add lines 62a–b)
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d
Enter gross amounts actually paid if different from gross amounts reported .
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 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
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.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
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(2)**Total U.S. source substitute payments reported other than substitute dividend payments
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c
Total gross amounts reported(add lines 62a–b)
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d
Enter gross amounts actually paid if different from gross amounts reported .
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 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
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(2)**Total U.S. source substitute payments reported other than substitute dividend payments
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c
Total gross amounts reported(add lines 62a–b)
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d
Enter gross amounts actually paid if different from gross amounts reported .
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 62
Total gross amounts reported on all Forms 1042-S and 1000:
a
Total U.S. source FDAP income (other than U.S. source substitute payments) reported .
.
.
.
.
b
Total U.S. source substitute payments reported:
**(1)Total U.S. source substitute dividend payments reported .
.
.
.
.
.
.
.
.
.
.
.
.
.
(2)**Total U.S. source substitute payments reported other than substitute dividend payments
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c
Total gross amounts reported(add lines 62a–b)
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d
Enter gross amounts actually paid if different from gross amounts reported .
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 62d
62 Total gross amounts reported on all Forms 1042-S and 1000:
a Total U.S. source FDAP income (other than U.S. source substitute payments) reported . . . . .
b Total U.S. source substitute payments reported:
(1) Total U.S. source substitute dividend payments reported . . . . . . . . . . . . . .
(2) Total U.S. source substitute payments reported other than substitute dividend payments . . .
c Total gross amounts reported (add lines 62a–b) . . . . . . . . . . . . . . . . .
d Enter gross amounts actually paid if different from gross amounts reported . . . . . . . . .		 62a
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Sign
Here		 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
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signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
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signature
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
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signature
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
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signature
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
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signature
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Sign
Here		 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
Date
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer
has any knowledge.
Your
signature
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self-employed		 Check if
self-employed		 Check if
self-employed		 PTIN PTIN PTIN PTIN
Paid
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Preparer
Use Only		 Firm’s name Firm’s name Firm’s name Firm’s name Firm’s EIN Firm’s EIN Firm’s EIN Firm’s EIN Firm’s EIN Firm’s EIN Firm’s EIN
Paid
Preparer
Use Only		 Paid
Preparer
Use Only		 Firm’s address Firm’s address Firm’s address Firm’s address Phone no. Phone no. Phone no. Phone no. Phone no. Phone no. Phone no.

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11384V Form 1042 (2025) Created 8/25/25

Form 1042 (2025) Page 2

6

Section 3 Potential Section 871(m) Transactions

Check here if any payments (including gross proceeds) were made by the withholding agent under a potential section 871(m) transaction, including a notional principal contract or other derivatives contract that references (in whole or in part) a U.S. stock or

If the box is checked, you must do the following. (1) Attach Schedule(s) Q (Form 1042). See instructions. (2) Enter your EIN (other than your QI-EIN)

Form 1042 (2025)

Exceptions & meaning →

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