---
type: tax-form
category: tax
person: Xuewei Jiang
date: 2015-12-31
source: lu_1042_baylor_2015.pdf
---

# Form 1042-S - Baylor University (2015)

Foreign Person's U.S. Source Income Subject to Withholding

## Key Information

| Field | Value |
|---|---|
| Income code | 20 |
| Gross income | $1,975 |
| Chapter 3 indicator | X |
| Exemption code (3a) | 04 |
| Exemption code (4a) | 16 |
| Tax rate (3b) | 0.00% |
| Tax rate (4b) | 0.00% |
| Federal tax withheld | $0 |
| Net income | $0 |
| Tax withheld by other agents | $0 |
| Total withholding credit | $0 |
| Tax paid by withholding agent | $0 |
| Amount repaid to recipient | $0 |
| State income tax withheld | $0 |
| State | TX |

## Withholding Agent

| Field | Value |
|---|---|
| Name | Baylor University, Mark C. Falsone |
| EIN | 74-1159753 |
| Ch. 3 status code | 20 |
| Address | P.O. Box 97042 |
| City/State/ZIP | Waco, TX 76798-7042 |

## Recipient

| Field | Value |
|---|---|
| Name | Xuewei Jiang |
| U.S. TIN | 092-99-3215 |
| Foreign ID | 092993215 |
| Ch. 3 status code | 16 |
| Country code | CH |
| Account number | 891545196 |
| Date of birth | 03/13/1993 |
| Address | 1-1-401, Huangtai South Road 79# |
| City/Country | Jinan, Shandong, China, People's Republic of 250014 |

## Copies

- Copy D for Recipient (page 1) and Copy B for Recipient (page 1 top half)
- Copy C for Recipient (page 2)