Form Mrw Reg - Registration For Mineral Royalty Withholding
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1MONTANA
MRW Reg
New 09-07
Registration for Mineral Royalty Withholding
1.
Account type: Mineral Royalty Withholding (MRW)
2. Federal employer identification number (FEIN)
3. Social security number (SSN)
4. Legal business name
5. Assumed business name (dba)
6.
Physical address
Street address
City
State
Zip
7.
Mailing address
PO Box/Street address
City
State
Zip
8.
Name of the person whom we can contact regarding this account.
Contact’s name
Phone number
FAX number
Email
9.
Legal entity type:
__ Sole Proprietor
__ Partnership
__ C corp
__ S corp
__ Member Managed LLC
__ Manager Managed LLC
__ LLP
__ Publicly Traded Partnership
__ Other (Please Indicate): _______________________________________________________
10. List the information for the individual owner if you are a sole proprietor, all partners if you are a partnership, all corporate officers
if you are a corporation, or all members if you are a limited liability company. (Use additional sheet if necessary.)
Social Security or Federal Employer
Name
Phone Number
Identification number
11. Purpose of registration:
X
__ Initial registration
__ Purchased an existing business or property
__ Re-registration
__ Entity change
__ Started a new business
__ Other (attach explanation)
12. List the previous name, owner and date acquired if you purchased an existing business, or the previous name if there is a
business name change.
Previous Business Name
Previous Owner
Date Acquired
13. Indicate all that apply:
Mineral Royalty
__ Oil
__ Gas
__ Coal
Withholding
__ Other Mineral (Please Indicate): ________________________________________________
14. Signature of owner, partner, or officer (unsigned forms will be returned.) Date
Phone Number
Email
15. Print the name of the owner, partner or officer who signed on line 14.
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Parent category: Financial