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Calendar Year: January 1, 2014 through December 31, 2014 Fiscal Year:

Members with less than $1,000 in RI source income (see instructions)Cannot distribute due to Federal or State restrictions (see instructions)

WITHHOLDING CALCULATION

1aRhode Island source income of nonresident members net of modification .............1

Rhode Island nonresident pass-through withholding rate........................................ 2b2

3aRhode Island pass-through withholding. Multiply line 1 by line 2............................. 3b3

4TOTAL Rhode Island pass-through withholding. Add lines 3a and 3b.........................................................................4

5Rhode Island nonresident real estate withholding (see worksheet on page 2 for other payments)............................5

6Tentative Rhode Island withholding for members. Subtract line 5 from line 4 (not less than zero)....................................6

7Rhode Island estimated tax paid on form RI-1096PT-ES ........................................7

Credit for withholding paid on behalf of reporting entity. Enter the identification 8

8anumber(s) of issuing entity or entities below. (see instructions) ....................................

ID #

8b

8 Rhode Island nonresident withholding on real estate sales in 2014 ONLY if entity

Other payments....................................................................................................... 8c8

Total payments and credits. Add lines 7, 8a, 8b and 8c...............................................................................................9

a

b

c

name, not members’ names, was provided to Division of Taxation at time of closing .....

to the RI-1099PTs being issued. Remit payment for balance due, plus any 2210PT interest, using Form RI-1096V.

Check if the RI-2210PT is attached.Enter interest due $__________and attach the RI-2210PT to the return.

10 Balance due. If line 6 is greater than line 9, subtract line 9 from line 6. The amount from line 6 should be allocated

10

Column A

C Corporations only

Column A

Sub S Corps, Individuals, LLCs, Partnerships & Trusts

9.0% 5.99%

be allocated to the RI-1099PTs being issued to the entity’s members. Excess amounts cannot be refunded or carried forward. 11

11 Excess withholding paid. If line 9 is greater than line 6, subtract line 6 from line 9. The amount on line 9 should

NOTE: The total withholding from all RI-1099PTs that have been issued must

equal the amount from line 6 or line 9 above, whichever is larger.

Attach all ISSUED RI-1099PTs to the BACK of this Form RI-1096PT.

1b

2a

9

Number of 1099s issued:

Total amount of 1099s issued:

MM/DD/2014 through MM/DD/____

State of Rhode Island and Providence Plantations

2014 Form RI-1096PTPass-through Withholding Return and Transmittal

Name

Address

City, town or post office

Address 2

State ZIP code

Federal employer identification number

Sub S Corp

Amended

Trust

E-mail address

LLC

Partnership

Year end

Check � ifextension is

attached.

Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908

DRAFT

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State of Rhode Island and Providence Plantations

2014 Form RI-1096PTPass-through Withholding Return and Transmittal

Name Federal employer identification number

Rhode Island source income of ALL nonresident C Corporation members net of modifications(attach schedule) ..........................................................................................................................

11

Rhode Island source income of those nonresident C Corporation members with income of lessthan $1,000 net of modifications (attach schedule) ......................................................................

22

Rhode Island source income of nonresident C Corporation members with income of $1,000 ormore net of modifications. Subtract line 2 from line 1. Enter here and on pg 1, Col A, Line 1a

33

Column AC Corporations

SCHEDULE A - CALCULATION FOR AN ENTITY WITH AT LEAST ONE C CORP MEMBER WITH LESS THAN $1,000.00 OF INCOME

Column BNumber ofMembers

Rhode Island source income of ALL nonresident members other than C Corporations net ofmodifications (attach schedule) ....................................................................................................

11

Rhode Island source income of those nonresident members other than C Corporations with in-come of less than $1,000 net of modifications (attach schedule) .................................................

22

Rhode Island source income of nonresident members other than C Corporations with income of $1,000 ormore net of modifications. Subtract line 2 from line 1. Enter here and on page 1, Column B, Line 1b

33

Column ASub S Corps, Individuals, LLCs,

Partnerships and Trusts

SCHEDULE B - CALCULATION FOR AN ENTITY WITH AT LEAST ONE NON-C CORP MEMBER WITH LESS THAN $1,000.00 OF INCOME

Column BNumber ofMembers

WORKSHEET FOR PAGE 1, LINE 5

Rhode Island nonresident real estate withholding - ONLY include if a breakdown of each shareholder’s with-holding amount was provided to the RI Division of Taxation at the time of closing - Attach copy of 71.3 form

5a

Rhode Island estimated tax paid by members on their personal return attributable to income on this return (see in-structions).

5b5b

Excess Rhode Island withholding tax paid by this entity for members (see instructions)............................................ 5c5c

5dRhode Island Historic Preservation Investment Tax Credit, Historic Tax Credits 2013, Motion Picture ProductionTax Credit, Musical &Theatrical Production Tax Credits or Credits for Contributions to Scholarship Organizations

5d

5eTotal. Add lines 5a, 5b, 5c and 5d. Enter here and on page 1, line 5........................................................................5e

5a

Authorized officer signature Print name Date Telephone number

Paid preparer address City, town or post office State ZIP Code PTIN

Paid preparer signature Print name Date Telephone number

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge andbelief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

May the Division of Taxation contact your preparer? YES

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