Form Pwe - Nonresident Passthrough Entity Member Withholding Exemption And Certification
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1FORM PWE - Nonresident Passthrough Entity Member
Withholding Exemption and Certification
NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
SFN 28754 (7-2015)
Part 1 - Nonresident PTE member information
Nonresident PTE member name
Federal employer identification number*
Mailing address
City
State
ZIP Code
Telephone number
Contact name
Email address
Entity type - Indicate how the entity is filing for federal income tax purposes by checking the appropriate box:
Partnership
S corporation
Trust
Grantor trust
Disregarded entity
If "Grantor trust" or "Disregarded entity"
Name of settlor/owner ______________________________________
is checked, identify settlor or owner
Social security number or FEIN* ______________________________
Part 2 - Passthrough entity information
Federal employer identification number*
Passthrough entity name
Mailing address
City
State
ZIP Code
Email address
Contact name
Contact name
Telephone number
Entity type - Indicate how the entity is filing for federal income tax purposes by checking the appropriate box:
Partnership
S corporation
Trust
Grantor trust
Disregarded entity
If "Grantor trust" or "Disregarded entity"
Name of settlor/owner ______________________________________
is checked, identify settlor or owner
Social security number or FEIN* ______________________________
Part 3 - Nonresident PTE member election and certification for exemption
Pursuant to N.D.C.C. § 57-38-31.1, the nonresident PTE member (in Part 1) elects exemption from income tax witholding on its
North Dakota distributive share of income from the passthrough entity (in Part 2), starting with the following tax year:
Calendar year
, _________ and ending ________________________, ________
Fiscal year beginning
This election remains in effect for all subsequent tax years until revoked.
Certification - The nonresident PTE member (in Part 1) certifies that it will file any return and pay any tax required under
N.D.C.C. ch. 57-38 and that it is subject to North Dakota's jurisdiction for the collection of the tax, and any applicable penalty and
interest, on its North Dakota distributive share of income from the passthrough entity (in Part 2).
Part 4 - Nonresident PTE member revocation of exemption
The nonresident PTE member (in Part 1) revokes the election and certification made on a Form PWE previously given to the
passthrough entity (in Part 2). This revocation is effective beginning with the following tax year:
Calendar year
, _________ and ending ________________________, ________
Fiscal year beginning
Part 5 - Nonresident PTE member signature
I declare, under penalty of perjury, that this form is correct and complete to the best of my knowledge and belief.
Printed name of authorized representative of nonresident PTE member
Title
Date signed
Signature of authorized representative
*Privacy Act - See instructions
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