Form Der-1 - Montana Disregarded Entity Information Return - State Of Montana 2006 Page 2

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Schedule I
Disregarded entity name _________________________
Tax period ending ______________________________
SSN/FEIN______________________________
Disregarded Entity Owner Information
Enter the total number of owners ________
Complete columns E through G for a nonresident individual, foreign C corporation or second-tier pass-through entity
Nonresident individual, foreign C corporation and
All Owners
second-tier pass-through entity owner information
A
B
C
D
E
F
G
Consent
Name and address of owner
C. Corporation
Social Security Number
(
)
Other Owner
Ownership
Montana source
agreement or
Owner
Name
OR Federal Employer
Withholding
%
income
statement (enter
Withholding
Street Address
Identification Number
6.9%
year signed)
6.75%
City | State | Zip Code
SSN
1.
FEIN
SSN
2.
FEIN
SSN
3.
FEIN
SSN
4.
FEIN
SSN
5.
FEIN
SSN
6.
FEIN
SSN
7.
FEIN
Column Totals
Use additional sheets if necessary or you may create your own schedule if you use the exact same format used here.

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