Form 1040NR (2004), Page 4. Summary: This is an example of Form 1040NR (2004), page 4, with items included as described in the text. Additionally, these
line items are
completed:
| “74a. Dividends paid by: U.S. corporations (c) 15%” field contains 240 |
| “84. Total U.S. tax withheld at source. Add column (a) of lines 74a through 83. Enter the total here and on Form 1040NR, line
65” field
contains 36 |
| “85. Add lines 74a through 83 in columns (b)-(e): (c) 15%” field contains 240 |
| “86. Multiply line 85 by rate of tax at top of each column” field contains 36 |
| “87. Tax on income not effectively connected with a U.S. trade or business. Add columns (b)-(e) of line 86. Enter the total
here and on Form
1040NR, line 51” field contains 36 |
