Foreign Person's U.S. Source Income Subject To Withholding: Copy B
Foreign Person's U.S. Source Income Subject To Withholding: Copy B
Foreign Person's U.S. Source Income Subject To Withholding: Copy B
Copy B
Department of the Treasury
Internal Revenue Service 8 0 3 5 4 1 3 5 5 4 UNIQUE FORM IDENTIFIER AMENDED 0 AMENDMENT NO. for Recipient
1 Income 2 Gross income 3 Chapter indicator. Enter “3” or “4” 3 13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code 16
code
3a Exemption code 04 4a Exemption code 21 13g Ch. 4 status code
12 2 3b Tax rate 00 . 00 4b Tax rate 00 . 00 13h Recipient’s GIIN 13i Recipient’s foreign tax identification 13j LOB code
number, if any
5 Withholding allowance
6 Net income *****568Y
7a Federal tax withheld -0- 13k Recipient’s account number
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) . . . . . . 13l Recipient’s date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a 1 9 8 0 0 2 1 8
partnership interest . . . . . . . . . . . . . .
8 Tax withheld by other agents 14a Primary Withholding Agent’s Name (if applicable)
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
( ) 14b Primary Withholding Agent’s EIN
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
0 15a Intermediary or flow-through entity’s 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
22-3328810 15 02 15e Intermediary or flow-through entity’s GIIN
12d Withholding agent’s name 15f Country code 15g Foreign tax identification number, if any
CD Baby, A Division of Audio and Video Labs, Inc.
12e Withholding agent’s Global Intermediary Identification Number (GIIN) 15h Address (number and street)
12f Country code 12g Foreign tax identification number, if any 15i City or town, state or province, country, ZIP or foreign postal code
US
12h Address (number and street) 16a Payer’s name 16b Payer’s TIN
9600 NE Cascades Parkway, Suite 180 CD Baby, A Division of Audio and Video Labs, Inc. 22-3328810
12i 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
Portland, OR, United States, 97220 15 02
13a Recipient’s name 13b Recipient’s country code 17a State income tax withheld 17b Payer’s state tax no. 17c Name of state
Francisco Silva Castignani SP
13c Address (number and street)
Calle Luis Cabrera 90 4E
13d City or town, state or province, country, ZIP or foreign postal code
Madrid, Madrid, Spain, 28002
(keep for your records) Form 1042-S (2022)
U.S. Income Tax Filing Requirements Por regla general, todo extranjero no residente, todo organismo
fideicomisario extranjero no residente y toda sociedad anónima
Generally, every nonresident alien individual, nonresident alien extranjera que reciba ingresos en los Estados Unidos, incluyendo
fiduciary, and foreign corporation with U.S. income, including income ingresos relacionados con la conducción de un negocio o comercio
that is effectively connected with the conduct of a trade or business in dentro de los Estados Unidos, deberá presentar una declaración
the United States, must file a U.S. income tax return. However, no estadounidense de impuestos sobre el ingreso. Sin embargo, no se
return is required to be filed by a nonresident alien individual, requiere declaración alguna a un individuo extranjero, una sociedad
nonresident alien fiduciary, or foreign corporation if such person was anónima extranjera u organismo fideicomisario extranjero no
not engaged in a trade or business in the United States at any time residente, si tal persona no ha efectuado comercio o negocio en los
during the tax year and if the tax liability of such person was fully Estados Unidos durante el año fiscal y si la responsabilidad con los
satisfied by the withholding of U.S. tax at the source. Corporations file impuestos de tal persona ha sido satisfecha plenamente mediante
Form 1120-F; all others file Form 1040-NR. You may get the return retención del impuesto de los Estados Unidos en la fuente. Las
forms and instructions at IRS.gov, at any U.S. Embassy or consulate, sociedades anónimas envían el Formulario 1120-F; todos los demás
or by writing to: Internal Revenue Service, 1201 N. Mitsubishi contribuyentes envían el Formulario 1040-NR. Se podrá obtener
Motorway, Bloomington, IL 61705-6613. formularios e instrucciones en IRS.gov y en cualquier Embajada o
En règle générale, tout étranger non-résident, tout organisme Consulado de los Estados Unidos o escribiendo directamente a:
fidéicommissaire étranger non-résident et toute société étrangère Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington,
percevant un revenu aux Etats-Unis, y compris tout revenu dérivé, en IL 61705-6613.
fait, du fonctionnement d’un commerce ou d’une affaire aux Etats- Im allgemeinen muss jede ausländische Einzelperson, jeder
Unis, doit produire une déclaration d’impôt sur le revenu auprès des ausländische Bevollmächtigte und jede ausländische Gesellschaft mit
services fiscaux des Etats-Unis. Cependant aucune déclaration Einkommen in den Vereinigten Staaten, einschliesslich des
d’impôt sur le revenu n’est exigée d’un étranger non-résident, d’un Einkommens, welches direkt mit der Ausübung von Handel oder
organisme fidéicommissaire étranger non-résident, ou d’une société Gewerbe innerhalb der Staaten verbunden ist, eine
étrangère s’ils n’ont pris part à aucun commerce ou affaire aux Etats- Einkommensteuererklärung der Vereinigten Staaten abgeben. Eine
Unis à aucun moment pendant l’année fiscale et si les impôts dont ils Erklärung, muss jedoch nicht von Ausländern, ausländischen
sont redevables, ont été entièrement acquittés par une retenue à la Bevollmächtigten oder ausländischen Gesellschaften in den
source sur leur salaire. Les sociétés doivent faire leur déclaration Vereinigten Staaten eingereicht werden, falls eine solche Person
d’impôt en remplissant le formulaire 1120-F; tous les autres während des Steuerjahres kein Gewerbe oder Handel in den
redevables doivent remplir le formulaire 1040-NR. On peut se procurer Vereinigten Staaten ausgeübt hat und die Steuerschuld durch
les formulaires de déclarations d’impôts et les instructions y afférentes Einbehaltung der Steuern der Vereinigten Staaten durch die
à IRS.gov et dans toutes les ambassades et tous les consulats des Einkommensquelle abgegolten ist. Gesellschaften reichen den
Etats-Unis. L’on peut également s’adresser pour tout renseignement Vordruck 1120-F ein; alle anderen reichen das Formblatt 1040-NR ein.
à: Internal Revenue Service, 1201 N. Mitsubishi Motorway, Einkommensteuererklärungen und Instruktionen können unter IRS.gov
Bloomington, IL 61705-6613. und bei den Botschaften und Konsulaten der Vereinigten Staaten
eingeholt werden. Um weitere Informationen wende man sich bitte an:
Internal Revenue Service, 1201 N. Mitsubishi Motorway,
Bloomington, IL 61705-6613.
1 This code should only be used if the income paid is described in Regulations section 1.1441-6(c)(2) and the withholding agent has reduced the rate of withholding under an
income tax treaty without the recipient providing a U.S. or foreign TIN.
2 If compensation that otherwise would be covered under Income Codes 17 through 20 is directly attributable to the recipient’s occupation as an artist or athlete, use
Income Code 42 or 43 instead.
Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding
▶ Go to www.irs.gov/Form1042S for instructions and the latest information.
2022 for Recipient
OMB No. 1545-0096
Copy C
Department of the Treasury
Internal Revenue Service 8 0 3 5 4 1 3 5 5 4 UNIQUE FORM IDENTIFIER AMENDED 0 AMENDMENT NO. Attach to any Federal tax return you file
1 Income 2 Gross income 3 Chapter indicator. Enter “3” or “4” 3 13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code 16
code
3a Exemption code 04 4a Exemption code 21 13g Ch. 4 status code
12 2 3b Tax rate 00 . 00 4b Tax rate 00 . 00 13h Recipient’s GIIN 13i Recipient’s foreign tax identification 13j LOB code
number, if any
5 Withholding allowance
6 Net income *****568Y
7a Federal tax withheld -0- 13k Recipient’s account number
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) . . . . . . 13l Recipient’s date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a 1 9 8 0 0 2 1 8
partnership interest . . . . . . . . . . . . . .
8 Tax withheld by other agents 14a Primary Withholding Agent’s Name (if applicable)
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
( ) 14b Primary Withholding Agent’s EIN
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
0 15a Intermediary or flow-through entity’s 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
22-3328810 15 02 15e Intermediary or flow-through entity’s GIIN
12d Withholding agent’s name 15f Country code 15g Foreign tax identification number, if any
CD Baby, A Division of Audio and Video Labs, Inc.
12e Withholding agent’s Global Intermediary Identification Number (GIIN) 15h Address (number and street)
12f Country code 12g Foreign tax identification number, if any 15i City or town, state or province, country, ZIP or foreign postal code
US
12h Address (number and street) 16a Payer’s name 16b Payer’s TIN
9600 NE Cascades Parkway, Suite 180 CD Baby, A Division of Audio and Video Labs, Inc. 22-3328810
12i 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
Portland, OR, United States, 97220 15 02
13a Recipient’s name 13b Recipient’s country code 17a State income tax withheld 17b Payer’s state tax no. 17c Name of state
Francisco Silva Castignani SP
13c Address (number and street)
Calle Luis Cabrera 90 4E
13d City or town, state or province, country, ZIP or foreign postal code
Madrid, Madrid, Spain, 28002
Form 1042-S (2022)
Explanation of Codes (continued) 06 QI that assumes primary withholding responsibility
20 Compensation during studying and training2 07 WFP or WFT
23 Other income 08 U.S. branch treated as U.S. Person
24 Qualified investment entity (QIE) distributions of capital 09 Territory FI treated as U.S. Person
gains 10 QI represents that income is exempt
25 Trust distributions subject to IRC section 1445 11 QSL that assumes primary withholding responsibility
26 Unsevered growing crops and timber distributions by a trust 12 Payee subjected to chapter 4 withholding
subject to IRC section 1445 22 QDD that assumes primary withholding responsibility
27 Publicly traded partnership distributions subject to IRC 23 Exempt under section 897(l)
section 1446 24 Exempt under section 892
28 Gambling winnings3 Chapter 4
32 Notional principal contract income4 13 Grandfathered payment
35 Substitute payment—other 14 Effectively connected income
Other
2 If compensation that otherwise would be covered under Income Codes 17 through 20 is directly attributable to the recipient’s occupation as an artist or athlete, use
Income Code 42 or 43 instead.
3 Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.
4 Use appropriate Interest Income Code for embedded interest in a notional principal contract.
5 Income Code 43 should only be used if Letter 4492, Venue Notification, has been issued by the Internal Revenue Service (otherwise, use Income Code 42 for earnings
as an artist or athlete). If Income Code 42 or 43 is used, Recipient Code 22 (artist or athlete) should be used instead of Recipient Code 16 (individual), 15 (corporation),
or 08 (partnership other than withholding foreign partnership).
6 Use only to report gross income the tax for which is being deposited in the current year because such tax was previously escrowed for chapters 3 and 4 and the
withholding agent previously reported the gross income in a prior year and checked the box to report the tax as not deposited under the escrow procedure. See the
instructions to this form for further explanation.
7 This code should only be used if no other specific chapter 3 exemption code applies.
8 Use only to report a U.S. reportable account or nonconsenting U.S. account that is receiving a payment subject to chapter 3 withholding.
9Use only if applying the escrow procedure for dormant accounts under Regulations section 1.1471-4(b)(6). If tax was withheld and deposited under chapter 3, do not
check box 7b (“tax not deposited with IRS pursuant to escrow procedure”). You must instead enter “3” in box 3 and complete box 3b.
Form 1042-S Foreign Person’s U.S. Source Income Subject to Withholding
▶ Go to www.irs.gov/Form1042S for instructions and the latest information.
2022 for Recipient
OMB No. 1545-0096
Copy D
Department of the Treasury
Internal Revenue Service 8 0 3 5 4 1 3 5 5 4 UNIQUE FORM IDENTIFIER AMENDED 0 AMENDMENT NO. Attach to any state tax return you file
1 Income 2 Gross income 3 Chapter indicator. Enter “3” or “4” 3 13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code 16
code
3a Exemption code 04 4a Exemption code 21 13g Ch. 4 status code
12 2 3b Tax rate 00 . 00 4b Tax rate 00 . 00 13h Recipient’s GIIN 13i Recipient’s foreign tax identification 13j LOB code
number, if any
5 Withholding allowance
6 Net income *****568Y
7a Federal tax withheld -0- 13k Recipient’s account number
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) . . . . . . 13l Recipient’s date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a 1 9 8 0 0 2 1 8
partnership interest . . . . . . . . . . . . . .
8 Tax withheld by other agents 14a Primary Withholding Agent’s Name (if applicable)
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
( ) 14b Primary Withholding Agent’s EIN
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
0 15a Intermediary or flow-through entity’s 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
22-3328810 15 02 15e Intermediary or flow-through entity’s GIIN
12d Withholding agent’s name 15f Country code 15g Foreign tax identification number, if any
CD Baby, A Division of Audio and Video Labs, Inc.
12e Withholding agent’s Global Intermediary Identification Number (GIIN) 15h Address (number and street)
12f Country code 12g Foreign tax identification number, if any 15i City or town, state or province, country, ZIP or foreign postal code
US
12h Address (number and street) 16a Payer’s name 16b Payer’s TIN
9600 NE Cascades Parkway, Suite 180 CD Baby, A Division of Audio and Video Labs, Inc. 22-3328810
12i 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
Portland, OR, United States, 97220 15 02
13a Recipient’s name 13b Recipient’s country code 17a State income tax withheld 17b Payer’s state tax no. 17c Name of state
Francisco Silva Castignani SP
13c Address (number and street)
Calle Luis Cabrera 90 4E
13d City or town, state or province, country, ZIP or foreign postal code
Madrid, Madrid, Spain, 28002
Form 1042-S (2022)
Explanation of Codes (continued) 20 Passive NFFE with no Substantial U.S. Owners
10 Trust other than Withholding Foreign Trust 21 Publicly Traded NFFE or Affiliate of Publicly Traded NFFE
11 Withholding Foreign Trust 22 Active NFFE
12 Qualified Intermediary 23 Individual
13 Qualified Securities Lender—Qualified Intermediary 24 Section 501(c) Entities
14 Qualified Securities Lender—Other 25 Excepted Territory NFFE
15 Corporation 26 Excepted NFFE—Other
16 Individual 27 Exempt Beneficial Owner
17 Estate 28 Entity Wholly Owned by Exempt Beneficial Owners
18 Private Foundation 29 Unknown Recipient
19 International Organization 30 Recalcitrant Account Holder
20 Tax Exempt Organization (Section 501(c) entities) 31 Nonreporting IGA FFI
21 Unknown Recipient 32 Direct reporting NFFE
22 Artist or Athlete 33 U.S. reportable account
23 Pension 34 Nonconsenting U.S. account
24 Foreign Central Bank of Issue 35 Sponsored direct reporting NFFE
25 Nonqualified Intermediary 36 Excepted Inter-affiliate FFI
26 Hybrid entity making Treaty Claim 37 Undocumented Preexisting Obligation
35 Qualified Derivatives Dealer 38 U.S. Branch—ECI presumption applied
36 Foreign Government—Integral Part 39 Account Holder of Excluded Financial Account11
37 Foreign Government—Controlled Entity 40 Passive NFFE reported by FFI12
38 Publicly Traded Partnership 41 NFFE subject to 1472 withholding
Pooled Reporting Codes10 50 U.S. Withholding Agent—Foreign branch of FI
27 Withholding Rate Pool—General Pooled Reporting Codes
28 Withholding Rate Pool—Exempt Organization 42 Recalcitrant Pool—No U.S. Indicia
29 PAI Withholding Rate Pool—General 43 Recalcitrant Pool—U.S. Indicia
30 PAI Withholding Rate Pool—Exempt Organization 44 Recalcitrant Pool—Dormant Account
31 Agency Withholding Rate Pool—General 45 Recalcitrant Pool—U.S. Persons
32 Agency Withholding Rate Pool—Exempt Organization 46 Recalcitrant Pool—Passive NFFEs
Chapter 4 Status Codes 47 Nonparticipating FFI Pool
01 U.S. Withholding Agent—FI 48 U.S. Payees Pool
02 U.S. Withholding Agent—Other 49 QI-Recalcitrant Pool—GeneraI13
03 Territory FI—not treated as U.S. Person Box 13j. LOB Code (enter the code that best describes the
04 Territory FI—treated as U.S. Person applicable limitation on benefits (LOB) category that qualifies the
05 Participating FFI—Other taxpayer for the requested treaty benefits).
06 Participating FFI—Reporting Model 2 FFI LOB Code LOB Treaty Category
07 Registered Deemed-Compliant FFI—Reporting Model 1 FFI 02 Government – contracting state/political subdivision/local
08 Registered Deemed-Compliant FFI—Sponsored Entity authority
09 Registered Deemed-Compliant FFI—Other 03 Tax exempt pension trust/Pension fund
10 Certified Deemed-Compliant FFI—Other 04 Tax exempt/Charitable organization
11 Certified Deemed-Compliant FFI—FFI with Low Value 05 Publicly traded corporation
Accounts 06 Subsidiary of publicly traded corporation
12 Certified Deemed-Compliant FFI—Nonregistering Local 07 Company that meets the ownership and base erosion test
Bank 08 Company that meets the derivative benefits test
13 Certified Deemed-Compliant FFI—Sponsored Entity 09 Company with an item of income that meets the active trade
14 Certified Deemed-Compliant FFI—Investment Entity that or business test
does not maintain financial accounts 10 Discretionary determination
15 Nonparticipating FFI 11 Other
16 Owner-Documented FFI 12 No LOB article in treaty
17 U.S. Branch—treated as U.S. person
18 U.S. Branch—not treated as U.S. person (reporting under
section 1471)
19 Passive NFFE identifying Substantial U.S. Owners
10 Codes 27 through 32 should only be used by a QI, QSL, WP, or WT. A QI acting as a QDD may use only code 27 or 28.
11This code should only be used if income is paid to an account that is excluded from the definition of financial account under Regulations section 1.1471-5(b)(2) or
under Annex II of the applicable Model 1 IGA or Model 2 IGA.
12This code should only be used when the withholding agent has received a certification on the FFI withholding statement of a participating FFI or registered deemed-
compliant FFI that maintains the account that the FFI has reported the account held by the passive NFFE as a U.S. account (or U.S. reportable account) under its
FATCA requirements. The withholding agent must report the name and GIIN of such FFI in boxes 15d and 15e.
13 This code should only be used by a withholding agent that is reporting a payment (or portion of a payment) made to a QI with respect to the QI’s recalcitrant account holders.