Form Pt-Stm - Second Tier Pass-Through Entity Owner Statement And Request For Waiver Of The Requirement To Withhold Or Pay Composite Tax Page 2
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4D –
If any of the owners of an entity in a multi tier business structure are also pass-through entities complete part D (see
instructions). Include additional pages if necessary.
D – Pass-Through Entity Owner Information
Name (as it appears on the fi rst tier entity’s most recent federal tax return)
Federal Employer Identifi cation Number
-
Status Code (codes are listed in the instructions)
List each of the owners of this tiered entity and provide the requested information. Include additional pages if necessary.
1. Name
SSN or FEIN
Mailing Address
State
Zip Code
Status Code (codes are listed in the instructions)
If a S, PS or DE, complete part D.
Does this tiered entity owner fi le a Montana tax return?
Yes
No
Don’t Know
If the answer is either No or Don't Know, the fi rst tier entity must either withhold tax or pay composite tax on behalf of
the second tier entity.
2. Name
SSN or FEIN
Mailing Address
State
Zip Code
Status Code (codes are listed in the instructions)
If a S, PS or DE, complete part D.
Does this tiered entity owner fi le a Montana tax return?
Yes
No
Don’t Know
If the answer is either No or Don't Know, the fi rst tier entity must either withhold tax or pay composite tax on behalf of
the second tier entity.
3. Name
SSN or FEIN
Mailing Address
State
Zip Code
Status Code (codes are listed in the instructions)
If a S, PS or DE, complete part D.
Does this tiered entity owner fi le a Montana tax return?
Yes
No
Don’t Know
If the answer is either No or Don't Know, the fi rst tier entity must either withhold tax or pay composite tax on behalf of
the second tier entity.
4. Name
SSN or FEIN
Mailing Address
State
Zip Code
Status Code (codes are listed in the instructions)
If a S, PS or DE, complete part D.
Does this tiered entity owner fi le a Montana tax return?
Yes
No
Don’t Know
If the answer is either No or Don't Know, the fi rst tier entity must either withhold tax or pay composite tax on behalf of
the second tier entity.
*11EB0201*
*11EB0201*
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