Dokumendiregister | Rahandusministeerium |
Viit | 7-1.1/2494-1 |
Registreeritud | 28.05.2024 |
Sünkroonitud | 29.05.2024 |
Liik | Sissetulev kiri |
Funktsioon | 7 RIIGI FINANTSVARADE JA -KOHUSTUSTE HALDAMINE (RKO, RVO) |
Sari | 7-1.1 Raha- ja kapitalituru dokumendid (tehingukinnitused, maksekorraldused jne) ja kirjavahetus |
Toimik | 7-1.1/2024 |
Juurdepääsupiirang | Avalik |
Juurdepääsupiirang | |
Adressaat | State Street Bank and Trust CO |
Saabumis/saatmisviis | State Street Bank and Trust CO |
Vastutaja | Kaja Kannerma (Rahandusministeerium, Kantsleri vastutusvaldkond, Eelarvepoliitika valdkond, Riigikassa osakond) |
Originaal | Ava uues aknas |
SEINE & CD STATE STREET BANK AND TRUST CC P0 BOX 5010 B0STON, MA 02206-5010
001692 90045769522 90301 0 0000 0 000 0139 MINISTRY 0F FINANCE 0F THE REPUBLIC 0F ESTON SUUR AMEERIKA 1 TALLINN, 10122 ESTONIA
Rahanaus, fl(nlsteerium
28 -O5 ?U2t fr -1
OMBNo 1545-0096
Copy B for Recipient
Go to www irs.govIFormIO42S for klsbntctiona and the lateat information. 1 042—S 1 Foreign Person’s U.S. Source Income Subject To Wlthholding ©23
Department of the Treasury Internal Revenue Service 1 01 0 1 0 1 8 1 3 1 2 4 1 0 2 UNIQUE FORM IDENTIFIER AMENDED P.MENDMENT NO.
1 lncome 2 Gross income 3 Chapter indicator Enter ‘3’ or «4» 3 13e Recipient’s U.S. TIN, if any 13f Ch.3 status code 36 code
01 $82516.00 3a Exemption code 05 4a Exemption code 15 13g Ch.4 status code 27
3b Tax rate 00 00 4b Tax rata 00 00 13h Recipients GIIN 131 Recipient’s foreign tax identification 13J L0B code number, if any
5 Wthholding allowance
6 Net income
7a Federal tax withheld $0.00 13k Recipionts account number
0139 7b Check it federal tax withheld was not deposited with the IRS because
escrow procedures were applied (saa instructions) 131 Recipients date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect (0 a partnership interest .
8 Tax withheld by other agents $0.00 14a Primary Withholding Agent’s Name (it applicable)
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
($0.00) 14b Primary Withholding Agents EIN
10 Total withholding credit (combine boxes 7a, 8, and 9) 15 Check if pro-rata basis reporting EI $0.00 15a Intemiediary orflow-through entitys EIN, if any 15b Ch.3 status code 15c Ch.4 status code
11 Tax paid by withholding agent (amounts not withheld)(see instructions)
15d Intermediary or flow-through entity’s name
12a Withholding agent’s EIN 12b Ch.3 status code 12c Ch.4 status code
04-6258081 15 01 15e Intermediary orflow-through entitys GIIN
12d Withholding agent’s name 1Sf Country code 15g Foreign tax identification number, ifany SEINE & C0 STATE STREET BANK AND TRUST C0
12e \Mthholding agent’s Giobal Intermediary Identification Number (GIIN) 15h Address (number and street)
12f Country code 12g Foreign tax 1 entification number, if any 151 City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street) 16a Payeis name 16b Payers TIN
P0 BOX 5010
121 City or town, State or province, country, ZIP or foreign postal code 16c Payer’s GIIN 16d Ch 3 status code 16e Ch. 4 status code -
BOSTON MA 02206-5010
13a Recipient’s name 13b Recipient’s country code 17a State income tax withheld 17b Payer’s state tax no. 17c Name of state MINISTRY 0F FINANCE OF THE REPUBLIC OF EST0N EN
13c Address (number and street)
SLJURAMEERIKA1
9c,a: 13d City or town state or province Country ZIP or foreign postal code L
TALLINN EN 10122 -
(keep for your records) Form 1042—3 (2023)
Page 1 of 5
0016929004576952290301 000000000
Explanation of Godes Box 1. tncome Code. Code Typesoflncome
hterest 01 Interest paid by U.S obligors-general 02 lnterest paid on real property mortgages 03 Interest paid 10 controlling foreign corporations 04 Interest paid by foreign corporations 05 lnterest on tax-free covenant bonds 22 Interesl paid on deposit with a foreign branch of a domestic corporation or
partnership 29 Deposit interest 30 Original issue discounl (OlD) 31 Short-term OlD 33 Substitute paymenl-interest 51 Interest paid on certain actively lraded or publicly offered securities[1j 54 Substitute payments-interest from certain actively lraded or publicly offered
securities(1] DMdend
06 Dividends paid by liS. corporations-general 07 Dividends qualifying for direcl dividend rale 08 Dividends paid by foreign corporatons 34 Substilule payment-dividends 40 Olher dividend equivalenls under RC seclion 871(m) 52 Dividends paid on certain activeiy traded or pubiicly offered securilies[1] 53 Substilule paymenls-dividends from cerlain acliveiy traded or pubiiciy offered
securites[1 56 Dividend equivaients under RC seclion 871(m) as a resuil 01 appiying the
combined transaction rules Oer
09 Capilal gains 10 Industrial royaities 11 Motion picture or television copyright royaities 12 Other royalties (for example, copyrighl, software, broadcasting, endorsement
payments) 13 Royallies paid on certain publiciy offered securities[1] 14 Real property ineome and natural resourees royalties 15 Pens,ons, annuitres, alimony, andlor insurance premiums 16 Scholarship or fellowship grants 17 Compensation for independent personal services[2j 18 Compensalion for dependenl personal servrces[2] 19 Compensation for teaching[2J 20 Compensation during sludying and lraining[2j 23 Olher income 24 Qualified investment entity (OlE) distributions of capital gains 25 Twst distributions subject 10 IRC seetion 1445 26 Unsevered growing crops and limber dislribulrons by a trusl subject to
IRC section 1445 27 Publicly lraded parlriership distributions subject 10 IRC section 1446(a) 28 Gambling winnings[3] 32 Notional principal conlracl income[4) 35 Subetitute payment-other 36 Capilal gains dislribulions 37 Retum of capilal 38 Eligible deferred compensation items subject 10 IRC section 877A(d)(1) 39 Dislribulions from a nongrantor lrusl subject 10 1RC section 877A(f)(1) 41 Guaranlee of indebtedness 42 Earnings as en artist or athlete-no central withholding agreement[5j 43 Earnings as an artist or alhiete-cenlral wilhholding agreemenl[5] 44 Specified federal procurement paymenls 50 lncome previously reported under escrow procedure[6] 55 Taxable death benefils on iife insurance conlracts 57 Amount reaiized under IRC seetion 1446(f) 58 Pubiiciy lraded partnership distributions-undeterminect
Boxes 3a and 4a. Exemption Code (applies Wthe tax rata enterad in box 3b or 4b ts 00.00).
Code AuyforExamptio4l Chapter3
01 Effectiveiy connecled income 02 Exempl under 1RC[7] 03 income is not from U.S. 04 Exempl under tax lreaty 05 Portfoiio interest exempt under IRC 06 01 Ihal assumes primary wilhholding responsibility 07 WFP0rWFT 08 US. branch treated as U.S. Person 10 01 represenls ihal income is exempl 11 QSL that assumes primary withholding responsibility 12 Payee subjecled 10 chapler 4 wilhhoiding 22 QDD that essumes primary wilhholding responsibility 23 Exempt under section 897(i) 24 Exempt under section 892
See back of Copy C for sdditionai codes
U.S. Income Tax Filing Requlrements Generally, every nonresident alien individual, nonresident alien fiduciary, and foreign corporation with U.S. income, including income Ihat is effeclively connecled wilh the conduct of a Irade or business in the United States, must file a U.S. income lex retum. However, no return is required 10 be iiled by a nonresidenl alien individual, nonresident alien fiduciary, or foreign corporalion if such person wae not engaged in a trade or business in the United States at any time during the lex year and if the lex liabilily of such person was fuily satisfied by the withhoiding of U.S lex at the source. Corporalions tie Form 1120-1; ali olhers fiie Form 1 040-NR. You may get the return forme and inslruclions eI 1RS.gov, at any liS. Embassy or consuiale, or by wriling 10: lnlernai Revenue Service, 1201 N. Milsubiehi Molorway, Bioominglon, IL 61705-6613
En rgie gnraIe, tout tranger non-rsident, toul organisme fidrticommissaire lranger non-r6sidenl eI loute soci6l lrangre percevanl un revenu aux Etats-Unis, y compris loul revenu driv, en feit, du fonctionnement d’un commerce ou d’une affaire aux Etats-Unis, doit produire une d4ciaration d’impöl sur te revenu auprs des services tiscaux des ElaIs-Unis Cependanl aucune d&iaration d’impöt sur te revenu n’eet exig4e d’un 6tranger non-rsident, dun organisme lidicommissaire rtlranger non-utsidenl, ou d’une socit4 lrangre siis n’onl pris parI å aucun commerce ou affaire aux Etate-Unis aucun momenl pendant I’anne fiscale et ei lee impåts donl Is sont redevabies, ont 6l enlirement acquitls per une retenue å la source sur leur selaire. Lee soci6t6s doivenl faire leur odclaralion d’impöt en remphssanl le formulaire 1 120-F; lous lee autree redevabies doivent rempiir te forniuiaire 1040-NR. On paul se procurer lee formuiaires de dcIeralions d’impöls eI las instruclions y affrentes ä IRS.gov et dans toutes les smbassedes eI lous tee coneulels des Etals-Unis. Lon peul geiemenl sedreseer pour tout renseignement Internal Revenue Service, 1201 N. Milsubishi Molorway, Bioominglon, IL 61705-6613.
Por regia general, todo extranjero no residenle, todo organismo fideicomisario extranjero no residenle y loda sociedad enönima exlranjera que recibe ingresos en los Estados Unidos, incluyendo ingresoe reiacionedoe con ia conducciön de un negocio o comercio dentro de los Estados Unidos, deberå presenler una deciaraciön esladounidense de impuestos sobre ei ingreso. Sin embargo, no se requiere deciareciön aigune a un individuo extranjero, una sociedad enönirna extranjera u organismo fideicomisario extranjero no residente, si tai persona no ha efectuado comercio o negocio en los Estados Unidos duranle ei arto fiscai y eila responsabiiidad con los impueslos de lal persone he sido satisfectra ptenamenle mediante retenciön del impuesto de los Estados Unidos en la fuenle. Las sociededes anönimas envian ei Formuierio 1120-F; todos los dems contribuyentee envian ei Formulerio 1 040-NR. Se podut oblener formularios e inslrucciones en 1RS.gov y en cueiquier Embejada 0 Consuledo de los Eslados Unidos 0 escribiendo directamente a: lnlernai Revenue Service, 1201 N. Miteubishi Motorway, Bioominglon, IL 61705-6613.
Im atgemeinen muss jede eusländische Einzelperson, jeder ausltndieche Bevolimächligle und jede ausländisohe Gesellscheft mit Einkommen in den Vereinigten Steelen, einschhesshch des Einkommene, welches direkt mit der Aueubung von Handel oder Gewerbe innerhalb der Staelen verbunden ist, eine Einkommensteuererkiarung der Vereinigten Slaaten ebgeben. Eine Erkiärung, mues jedoch nicht von Ausländem, ausländischen Bevotmäctrtigten oder ausi8ndischen Geselischaften in den Vereinigten Staaten eingereichl werden, falls eine soiche Person wahrend des Steuerjshres kein Gewerbe oder Handel in den Vereiniglen Slaaten auegeubl heI und die Sleuerschuld durch Einbehaltung der Sleuern der Vereinigten Steaten durch die Einkommensquelie abgegollen ist. Geseliechaften reichen den Vordruck 1120-F ein; alle anderen reichen das Formblett 1040-NR ein. Einkommensteuererklärungen und lnslruklionen können unler IRS.gov und bei den Botschatten und Koneulaten der Vereiniglen Slaelen eingehoit werden. Um weilere informalionen wende man sieh bitle en: Internel Revenue Servine, 1201 N. Milsubiehi Motorway, Bloomington, IL 61705-6613.
[1) This code ehould only be used if the income paid is described in Regulatione seolion 1.1441 -6(c)(2) and the wilhholding agenl has reduced the rale of wilhhoiding under an income lex treely withoul the recipienl providing a liS. or foreign TIN. [2) lf nompeneation that otherwise wouid be covered under ineome Codes 17 lhrough 205 directly allributabie 10 Ihe recipienl’s occupalion as an ertist or athlele, usa ineome Code 42 or 43 instead.
Page 2 of 5
1 042—S 1 Foreign Person’s U.S. Source Income Subject To Withholding ©23 OMB No.
I o to ww rs.gov/FormIo42S for Insfrudlons end the Ietest Information. Deparlmenl of the Treasury
Copy C for Recipienl
Inlernal Revenue Servce 0 1 o 1 1 o 1 8 1 3 1 2 1 4 1 0 1 2 1 UNIQUE FORM IDENTIFIER L1 AMENDED AMENDMENT NO. Allach 10 any Federal lex return you file
1 Income 2 Gross income ndcalor. Enler ‘3” - 3 13e Recpient’s U.S. TIN, if any 13! Ch3 slatus code 36 code
01 $82516 00 3a Exemplion code 05 4a Exemption code 15 13g Ch.4 slalus code 27
3b Tee rata 00 00 4b Tax rale 00.00 13tt Recipients GIIN 131 Recipienls loreign lex idenhEcalion 13j LOB code number, 4 any
5 V1lhholding allowance
6 HeI income
7a Federal lex withheld $0.00 13k RecipienFs account number
0139 7b Check 4 federal lex wilhheld was fbI deposiled with the IRS because
escrow procedures were applied (see iflSlruCtiOflS) 131 Recpient’s dale 0! birth (YYYYMMDD)
7c Check 4 wllhhotcling occurred in subsequenl year wilh respect 10 a parlnershlp interesl
8 Tax wdhhetd by other agenls $0.00 14a Primary Wtlhholding Agenls Name (if applicable)
9 Overwilhhetd lex repaid 10 recipient pursuant 10 adjustment procedures (see nstwclions)
($0.00) 14b Primary Viiilhholding Agenls EIN
10 Tolal withholdirig credil (combine boxes 7a, 8, and 9) 15 Check 4 pro-rata basis reporling
$0 00 15a Intermediary or llow-lhrough entily’s EIN, 4 any 15b Ch.3 slalus code 5c Ch.4 slatus code
11 Tax paid by wilhhotding agenl (arrrounls fbI withheld)(see instruclions)
15d Intermediary or flow-lhrough enlity’s name
12a V1lhholding agenls EIN 12b Ch.3 slatus code 12c Ch.4 slalus code
04-6288081 15 01 ISe Inlermediary orflow-lhrough enlilys GIIN
12d V1thholding agerils narrte 151 Country code 15g Foreign lex dentificalion number, if any SEINE & CO STATE STREET BANK AND TRUST CO
12e V4thholding agents Giobal Intermediary ldenlihcalion Number (GIIN) 1511 Address (nuinber and street)
12! Country code 12g Foreign lex identifioalion number, 4 any 151 City or lown, slale or province, counlry, ZIP or foreign poslal code
12h Address (number and slreel) 16a Payer”s name 18b Payer’s TIN P0 BOX 5010
121 Cily or town, sIale or province, counlry. ZIP orforeign poslal code 16c Payer’s OlIN 16d Ch. 3 Slalus code 16e Ch. 4 elatus code
BOSTON MA 02206-5010
13a Recipienls name 13b Recipienl’s eounlry code 17a SIale income tax wilhheld 17b Payer’s slate lex no. 17c Name 0! sIale MINISTRY OF FINANCE OF THE REPUBLIC OF ESTON EN
13c Address (number and sIteet)
SUURAMEERIKA1 .
13d Cily or lown slate or province Country ZIP or foreign poslal code
TALLINN EN 10122 r
Form 1042-8 (2023)
Page3of5
00169290045769522903020 0000 0000
Explanation of Codes continuad
Chapter4 13 Grandfatharad payment 14 Effeclivaly connactad incoma 15 Payee not aubjact 10 chaptar 4 withholding 16 ExcIudad nontinancial paymant 17 Foraign Entity ttiat aasumas primary w4hholding raaponsibility 16 11.8. Payaas-of participating FF1 or ragisterad daamad-compliant FF1 19 Exampt kom withholding undar tGA(8j 20 Dormarit accouril[9] 21 Other-paymant not subjact 10 chaptar 4 withhotding
Boxea 12b, 12c, 13f 13g, 15D, ISo, 18d, and 16e. WthholdktgAgent, Reciplent Intaanadiaty, and Payer Chapter 3 and Ghapter 4 Statua Godaa.
Type of Reciplent, Wthholdfrig Agant Payer, or Intermediaiy Chapter 3 Statua Codea
11.5. branch-traatad as 11 8. Parson(10j 11.5. branch-not traatad aa 11.5 Parson[1 1] 11.5. branch-ECI prasumption appliad Partnarship othar than Withhotding Foraigri Partnarship or Publicly Tradad Partnarahip Wthholding Foraign Partnarahip Trust othar than Withholding Foraign Truat Wthholding Foraign Trust Qualifiad Intarmadiary Qualifiad Sacuritiaa Landar-Qualitiact Intarmadiary Qualitiad Sacuritias Landar-Othar Corporation Individual Estata Privata Foundation International Organization Tax Exempt Organization (Saction 501(c) entities) Unknown Recipient Artiat or Athlata Pension Foraign Central Bank ot lasue Nonqualitied tntarmediary Hybrid arttity making Traaty Ctaim Qualifiad Derivativea Daalar Foraign Govarnment-Intagral ParI Foraign Govarnmant-Controllad Entity Publicly Tradad Partnarahip Diaclosing Qualitiad Intarmediary
Pooled Reportlrtg Codes[12) Wthholding Rata Pool-Ganaral Withholding Rata PooI-Exampl Organination PAI Withholding Rata Pool-Ganaral PAI Vdthholding Rata PooI-Exampt Organization Agancy Wtthholding Rata Pool-Ganaral Agancy Wthholding Rata PooI-Exampt Organiaalion
Chapter 4 Statua Godes 01 U.5. Wthholding Agant-FI 02 11.5 Wthtrolding Agant-Othar 03 Tarritory Ft-not traatad es 11.8 Paraon 04 Tamtory Ft-traatad ea 11.5. Parson 05 Participating FFt-Othar 08 Participating FFt-Raporting Modal 2 FF1 07 Ragiatarad Daamad-Compliant FFI-Raporting Modal 1 FFt 08 Ragiaterad Daamad-Cornpliant FFI-Sponaorad Entity
09 Ragistarad Daamad-Compliant FFI-Othar 10 Cartitiad Daemad-Compliant FFt-Qthar 11 Cartifiad Deamad-Compliant FFt-FFI with Low Valua Accounta 12 Cartitiad Daamad-Compliant FFI-Nonragiatering Local Bank 13 Cartitiad Daamad-Compliant FFI-Sponaorad Entity 14 Cartitiad Daamad-Compliant FFI-Invaatmant Errtity that doaa not maintain
tinancial accounts 15 Nonpanicipating FF1 16 Ownar-Documantad FF1 17 11 5 Brench-traatad aa 11.5. paraon 16 liS. Branch-not traatad aa 11.5. paraon (raporting unctar saction 1471) 19 Pasaiva NFFE idantitying Subalantial U.S. Ownara 20 Passiaa NFFE with no Subatantial 11.5. Ownars 21 Publicly Tradad NFFE or Aifilieta ot Publicly Tradad NFFE 22 Activa NFFE 23 tndividual 24 Seelion 501(c) Entitiaa 25 Eecaptad Tarritory NFFE 26 Excapted NEFE-Othar 27 Exampt Banaficial Owner 28 Entily 1AhoIIy Ownad by Exampt Banaticial Ownare 29 Unknown Racipiant 30 Racalcitrant Account Holdar 31 Nonraporting IGA FFt 32 oireet raporting NFFE 33 11.5. raportabia eccount 34 Nonconeanting 11.8 account 35 Sponsorad diract raporting NFFE 36 Eacaptad Intar-attiliate FF1 37 Undocumantad Praaxisting Obiigation 38 11.8. Branch-ECt praaumption appliad 39 Account Holdar of Excludact Financial Account(13] 40 Pasaiva NFFE reportad by FFI(14] 41 NFFE aub)act to 1472 withholding 50 11.5. Withholding Agant-Eoraign branch of FI
Pooted Repo.Itng Godes 42 Racalcitranl Pool-No U.S. tndicia 43 Racalcitrent PooI-1l.5. Indicia 44 Racalcitrent PooI-Dorment Account 45 Racalcitrant PooI-U.S. Paraona 48 Racalcitrant Pool-Paasiva NFFEa 47 Nonperticipatirrg FFt Pool 48 liS. Payaas Pool 49 Qt-Racalcitrant PooI-Ganaral[1 5]
Box 13]. LOS Gode (antar Itte code IlmI best desoribes the appllcebla limitatton on benefits (LOS) cetegoty thst qual Sas the taxpeyer for the requested treaty benefits). LOS Code LOS Treaty Gategoty 02 Govarnmant - contracting atata!political aubdiviaionllocal authority 03 Tax asampt pansion truatlPanaion (und 04 Tee asamptlCharitabla organization 05 Publicly tradad corporalion 08 Subaidiary ot publicly tradad corporation 07 Company that maata tha ownamhip and baaa aroaion taat 08 Company that maata tha darivaliva banatita taat 09 Company with an itam ot incoma that maata tha activa trada or buainaaa taat 10 Diacretionary datarmination 11 Othar 12 No LOS articla in traaty
Gode
05 06 07 08
09 10 II 12 13 14 15 16 17 16 19 20 21 22 23 24 25 26 35 38 37 38 39
27 28 29 30 31 32
[31 Subject lo 30% wilhholding rata unleaa the recipient ia kom one of the treety countriea liated under Gambling winninge (Inccma Code 28) in Pub, 515. (4] Usa appropriate tntereat Income Code for embedded intereat in a notional principal contract [5] tncome Code 43 ahoutd only be uaed 4 Letter 4492, Venua Notification, haa been iaaued by the tnternal Revenue Semice )otherwiae, uae Income Code 42 for eaminga aa en ertiat or ethlete). tf Income Code 42 or 43 ia uaed, Recipient Code 22 (ertiat or ethlete) ehould be ueed ineteed ot Recipient Code 16 (individual), 15 (corporation(, cr08 (partnerahip other then withholding foreign pertnerehip or publicly treded pertrrerehip). [6) Usa only te report groaa income the tee for which ia baing depoaited in the current yeer becauae auch tee wea praviouely eecrowed for cheptare 3 and 4 and the withhotding agant previoualy raported the grosa incoma in e prior yaar and checked the box to raport the lex ee not dapoaited under the eacrow procedure, Saa the inatructione te thia form for further explanetion. [7] Thia code should only ba uaed if no olher apecific chepter 3 exemption code appliea. [8] Uaa only te report e 11 5. reponable account or nonconaenting U.5. eccount thet ia receiving e payment eub)ect to chepter 3 withholding. [9] Usa only 4 epptying the aacrow procedure for dorment accounta under Regulationa eeclion 11471 -4(b)(6) tf tex waa withheld and depoaited under chepter 3, do not check box 7b (“tax not depoaited with IRS purauent te aacrow procedure”). You muat inetaad entar “3” in box 3 and complete box 3b. [10] Thia code een be uaed by e Territory EI thet ia treeted aa a 11.5. peraon. [11] Thie code een be uaed by e Territory EI Ihet ia not treated ea e U.S peraon [12] Codee 27 through 32 ahould only he uaad by e 01, QSL, WP, or wr. AlI acting ase 000 may usa only code 27 or 28 [13] Thie code ehould only be ueed if income ia peid te en eccount thet ie eecluded from the detinition ot tinanciel eccount undar Reguletiona aaclion 1.1471 -5)b)(2) or ender Annex II of the appticeble Modet 1 IGA or Modet 2 IGA. [14] Thie code ahould only he uaed when the withholding egent haa racaived a cartitication on the EEI withholding atatement ot e perticipeting FF1 or ragietared deemed-compliant EEI thet mainteina the eccount thet the FF1 hea reported the eccount held by the peasive NEEE ea e 11.8. eccount (or U.S. raporteble eccount) under te EATCA raquirementa. The wittrtrotding agent muet report the neme and GIIN of auch FF1 in boxea 15d and 15a. [15] Thie code ahould only he uaed by e withholding egent that ia reporting a peyment (or portion ote peyment) made tee ei with reepect te the Ola recalcitrent ecccunt hoidere.
Pege4of5
1 042S 1 FeiWI Peon’s U.S. Source Income Subject To Withholding ©23 l OMB No 1545-0096
1 Go to www.Irs.govIFom1042S for Insbudlons and the test infofmatlon. Copy D for Recipient Department of the Treasury Internal Revenue Service 0 1 01 0 1 0 1 8 3 1 2 1 41 0 1 21 UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.
Attach to any state tax retum you Se
1 tncome 2 Gross income 3 Chapter indicator Enter’ or 4 3 13e Recipienrs U S TIN, if any 13f Ch 3 status code 36
code
0-1 $82516 00 3a Exemption code 05 4a Exemphon code 15 13g Ch 4 status code 27
3b Tax rate 00 00 4b Tee rate 00 96 13tt Recipients OlIN 131 Recipients foregn tax ident4ication 13J LOS code number, 4 any
5 V1thholding allowarice
6 Net income
7a Federal lex withheld $0 00 13k Recipients account number
0139
7b Check 1 federal tax withheld was fbI deposited with the IRS because escrow procedures were applied (see Instructions)
......... 131 Recipient’s date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect 10 a partnership interest
8 Tax withhelct by other agents $0.00 14a Primary Withholding Agents Name (if applicable)
9 Overwithheld tax repaid 10 recipent pursuant 10 adjustment procedures (see instructions)
($0.00> 14b Primary Withholding Agents EIN
10 Total withhoIdng credit (combine boxes 7a, 8, and 9> 15 Check 1 pro-rata basis reporting
soo 15a Intermediary or ftow-through entitys EIN, 4 any 15b Ch 3 status code 15c Ch.4 status code
11 Tax paid by withholding agent (amounts not withheld)(see instructions)
15d Intermediary orflow-through entitys narne
12a Wtthholding agents EIN 12b Ch.3 status code 12c Ch.4 status code
04-6288081 15 01 15e Intermediary or ftow-through entity s GIIN
12d Wthholding agents name 1Sf Country code 15g Foreign tax identification number, 4 any SEINE & Cl STATE STREET BANK AND TRUST Cl
12e Withholding agents GIobal Intermediary Identification Number (GIIN) 15tt Address (number and street)
12f Country code 12g Foreign tax identification nuriber, 4 any 151 City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street> 16a Payeis name 16b Payes TIN P0 BOX 5010
121 City or town, state or province, country, ZIP or foreign postal code 16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code
BOSTON MA 02206-5010
13a Recipient’s name 13b Recipients country code 17a State income tax withheld 17b Payer’s state tee no. 17c Name of state MtNtSTRY OF FINANCE OF THE REPUBLIC IF ESTIN EN
13c Address (number and street> .
SUUR AMEERIKA 1
13d City or town state or province country ZIP or foreign postal code
TALLINN EN 10122
Form 1042-8 (2023)
Page 5 of 5
0016929004576952290303 1 0000 0000