ScheduleM1W,MinnesotaIncomeTaxWithheld2016 Sequence #2 201631 Complete this schedule to report Minnesota income tax withheld. Include this schedule when you file your return. Your First Name and Initial Last Name If a Joint Return, Spouse's First Name and Initial Last Name Your Social Security Number Spouse's Social Security Number If you received a W-2, 1099, W-2G, Schedule KPI, KS, or KF that shows Minnesota income tax was withheld, complete this schedule to determine line 23 of Form M1. List only the forms that report Minnesota income tax withheld. Round dollar amounts to the nearest whole dollar. You must include this schedule when you file your return. DO NOT send in your W-2, 1099, or W-2G forms; keep them with your tax records. All instructions are included on this schedule. 1 Minnesota wages and tax withheld from W-2s, other than from W-2G. If you have more than five W-2s, complete line 5 on the back. A If the W-2 is for: · you, enter 1 · spouse, enter 2 B--Box 13 If Retirement Plan box is checked mark an X below. C--Box 15 Employer's 7-digit Minnesota state tax ID number D--Box 16 State wages, tips, etc. (round to nearest whole dollar) E--Box 17 Minnesota tax withheld (round to nearest whole dollar) MN MN MN MN MN Subtotal for additional W-2s (from line 5 on the back) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total Minnesota tax withheld from all W-2 forms (add amounts in line 1, column E) . . . . . . . . . . . . . . 1 2 Minnesota tax withheld from 1099 and W-2G forms. If you have more than four forms, complete line 6 on the back. A If the 1099 or W-2G is for: · you, enter 1 · spouse, enter 2 B Payer's 7-digit Minnesota state tax ID number (if unknown, contact the payer) C Income amount (see the table on the back for amounts to include) D Minnesota tax withheld (round to nearest whole dollar) MN MN MN MN Subtotal for additional 1099 and W-2G forms (from line 6 on the back) . . . . . . . . . . . . . . . . . . . . . . . . . . . Total Minnesota tax withheld from all 1099 and W-2G forms (add amounts in line 2, column D) . . . 2 3 TotalMinnesotataxwithheldbypartnerships,Scorporations,andfiduciaries (from line 7 on the back) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Total. Add the Minnesota tax withheld on lines 1, 2 and 3. Enter the total here and on line 23 of Form M1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 IncludethisschedulewithyourFormM1. Ifrequired,includeSchedulesKPI,KS,and/orKF. 9995 American LegalNet, Inc. www.FormsWorkFlow.com 2016 M1W, page 2 Complete line 5 and/or line 6 to report Minnesota income tax withheld if you received more than five W-2 forms or four 1099 and W-2G forms. Complete line 7 to report Minnesota tax withheld on Schedules KPI, KS, and/or KF. 5 Minnesota wages and Minnesota tax withheld on additional W-2s (other than W-2G). A If the W-2 is for: · · you, enter 1 spouse, enter 2 B--Box 13 If Retirement Plan box is checked mark an X below. C--Box 15 Employer's 7-digit Minnesota state tax ID number D--Box 16 State wages, tips, etc. (round to nearest whole dollar) E--Box 17 Minnesota tax withheld (round to nearest whole dollar) MN MN MN MN Subtotal for additional W-2s (add amounts in line 5, column E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Enter the result here and include on line 1 on the front of this schedule. Minnesota tax withheld on additional 1099 and W-2G forms. A If the 1099 or W-2G is for: · · you, enter 1 spouse, enter 2 B Payer's 7-digit Minnesota state tax ID number (if unknown, contact the payer) C Income amount (see the table on the back for amounts to include) D Minnesota tax withheld (round to nearest whole dollar) 6 MN MN MN MN Subtotal for additional 1099 and W-2G forms (add amounts in line 6, column D) . . . . . . . . . . . . . . . . . . . . . 6 Enter the result here and include on line 2 on the front of this schedule. 7 Minnesota income and tax withheld by partnerships, S corporations, and fiduciaries, if any. A Entity's 7-digit Minnesota state tax ID number (if unknown, contact the entity) B--MinnesotaIncomeAmount (from line 33 of Schedule KPI, line 31 of KS, and/or line 26 of KF) C--MinnesotaTaxWithheld (from line 35 of Schedule KPI, line 33 of KS, and/or line 17 of KF) MN MN MN MN Subtotal of Minnesota tax withheld by partnerships, S corporations, and fiduciaries (add amounts in line 7, column C). Enter the result here and on line 3 on the front of this schedule . . . . . . . . . . . . . . . . . . . 7 Use to determine which amounts from your 1099 form you must include as income on column C, lines 2 and 6. Form IncludetheSumofBoxes: Form IncludetheSumofBoxes: Form IncludetheSumofBoxes: 1099-G . . . . . . . . . . . 1, 2, 5­7 1099-INT. . . . . . . . . . . . . . 1 1099-K . . . . . . . . . . . . 1a 1099-MISC . . . . . . . . 1­3, 5­8, 10, 13, 14 1099-OID . . . . . . . . . . . . . 1, 2 1099-R . . . . . . . . . . . 14 or 2a or 1 1099-DIV . . . . . . . . . . 1a, 2a TableforColumnC,Lines2and6 9995 American LegalNet, Inc. www.FormsWorkFlow.com