Form Der-1 - Montana Disregarded Entity Information Return - 2004
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3MONTANA
2004 Montana Disregarded
DER-1
Rev. 2-05
Entity Information Return
For calendar year 2004 or tax year beginning_____________, 2004; ending_____________, 20_____
Name
Check box if this is
Check if
a change of address.
FEIN or SSN:
Applicable:
____Initial Return
Address
____Final Return
____Amended
City
State
Zip + 4
Business name(s):_____________________________________________________________________
1.
Date of first filing with the Montana Secretary of State:_________________________________________
2.
State or country where incorporated or formed:_______________________________________________
3.
1. Ordinary income (loss) from trade or business activities (Form 1120S, page 1, line 21)
1.
Date incorporated or formed:_____________________________________________________________
4.
2. Net income (loss) from rental real estate activities
2.
3. a. Gross income from other rental activities
3a.
Disregarded Entity Type (Check appropriate entity type)
5.
Expenses from other rental activities (attach schedule)
3b.
Net income (loss) from other rental activities (subtract line 3b from line 3a)
3.
Single Member Limited Liability Company
4. Portfolio income (loss):
Owner type (see listing under Where to File)____________________________________
a.
Interest income
4a.
If the single member is an individual who is a full-year Montana resident during the
b.
Dividend income
4b.
applicable reporting period, it is not necessary to file Form DER-1.
c.
Royalty income
4c.
d.
IRC § 761 Partnership
Net short-term capital gain/(loss) (attach Federal Schedule D)
4d.
e.
Date of IRC § 761 election:_________________________________________________
Net long-term capital gain/(loss) (attach Federal Schedule D)
4e.
Internal Revenue Service Center where the election is filed._______________________
f.
Other portfolio income (loss)
4f.
Total portfolio income
4.
IRC § 1361(b)(3) Qualified Subchapter S Subsidiary
5. Net gain (loss) under section 1231 (other than due to casualty or theft) (attach Form 4797)
5.
Date of IRC 1361(b)(3) election:_____________________________________________
6. Other income (loss)
6.
Internal Revenue Service Center where the election is filed:_______________________
7. Total lines 1 through 6
7.
8. Charitable contributions (attach schedule)
8.
IRC § 856(i)(2) Qualified Real Estate Investment Trust Subsidiary
9. Section 179 expense deduction (attach Form 4562)
9.
10.
Deductions related to portfolio income/(loss) (you must itemize)
10.
IRC § 860D Real Estate Mortgage Investment Conduit (REMIC). Attach a copy of Federal
11.
Other deductions (attach schedule)
11.
Form 1066.
12.
Total lines 8 through 11
12.
Payments
13.
Add:
a. Interest and dividends not taxable under the Internal
13a.
6.
Disregarded Entity Information Return Late File Penalty Payment
Revenue Code (non-Montana).
Disregarded entity late file penalty (see instructions)..............................................................
___________
6.
b. Taxes based on income or profits
13b.
c. Other additions (attach detailed breakdown)
13c.
Disregarded Entity Backup Withholding Estimated Payment from Schedule I
Total Montana additions to income
13.
7.
Montana corporation license tax withheld from Schedule I, column G...................
___________
7.
14.
Subtract:
a. Interest on U.S. Government Obligations (attach schedule) . .
14a.
8.
Montana individual income tax withheld from Schedule I, column H...................
___________
8.
b. Deduction for purchasing recycled material (attach Form RCYL)
14b.
9.
Total disregarded entity backup withholding estimated payments (add lines 7 and 8).............
___________
9.
c. Other deductions (attach detailed breakdown)
14c.
Total Montana deductions to income
14.
Disregarded Entity Combined Payment Due
15.
15.
Income taxable to shareholders (line 7 - line 12 + line 13 - line 14)
10.
Total payment due (total of lines 6 and 9)................................................................................
___________
10.
16.
16.
Multistate taxpayers: line 15 X ____________% from Schedule K, line 5
Declaration
17.
Multistate taxpayers: Income allocated directly to Montana
17.
I, the undersigned, declare that I am authorized to sign the disregarded entity return and that the return, including all
Payments
accompanying attachments, is, to the best of my knowledge and belief, true, correct and complete.
18.
18.
S. corporation late file penalty (see instructions)
Signature
Title
Telephone Number
Date
Check here, if you do not need the Montana Small Business Corporation Information Return and Instructions sent to you next year.
A copy of your Federal Form 1120S and Schedule K-1’s must be attached
164
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