Form Nmc - Nonresident Member Consent And Indemnification Agreement - Alabama Department Of Revenue
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1*XX0009NM*
ORM
XX0009NM
A
D
R
LABAMA
EPARTMENT OF
EVENUE
NM
Individual & Corporation Tax
3/2010
Nonresident Member Consent and Indemnification Agreement
Subchapter K Entity Information:
SUBCHAPTER K ENTITY NAME
FEDERAL ID NUMBER
STREET ADDRESS
CITY
STATE
ZIP
Nonresident Member Information:
MEMBER NAME
SSN / FEIN
STREET ADDRESS
CITY
STATE
ZIP
Agreement of the Nonresident Member:
I, ____________________________________________________, as a nonresident member of the above named subchapter K entity,
request that the subchapter K entity be excepted from the composite payment requirements of Section 40-18-24.2, Code of Alabama
1975, regarding my distributive share of income from the entity for the tax year _________ and all subsequent tax years, until I notify the
Alabama Department of Revenue, in writing, of my revocation of this consent agreement.
By signing this agreement, I agree to:
1. File all income tax returns in accordance with Alabama income tax law, and to make all income tax payments required by Alabama
income tax law;
2. Be subject to personal jurisdiction by the State of Alabama for the purpose of the collection of income taxes and any related interest
and penalties imposed on me by the State of Alabama with respect to my distributive share of the Income from the above named
subchapter K entity; and,
3. Waive any taxpayer confidentiality required by §40-2A-10, Code of Alabama 1975, as necessary to assess and collect any amount
owed by the above named subchapter K entity as a result of my distributive share of income from the subchapter K entity.
______________________________________________________ _____________________________
Signature of Nonresident Member
Date
Agreement of the Subchapter K Entity:
On behalf of the subchapter K entity, I agree to submit this document to the Alabama Department of Revenue, I agree to maintain a
copy of this executed document, I have verified the signature of the nonresident member, and I agree to indemnify the State of Alabama
concerning the composite payment required regarding the nonresident member’s distributive share of income during the period of this
agreement.
______________________________________________________ _____________________________
Signature of Subchapter K Entity or Manager
Date
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