Form Der-1 - 2011 Montana Disregarded Entity Information Return Page 3
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Form DER-1, Page 3
SSN
FEIN
OR
Schedule I - Disregarded Entity Owner Information
Enter the total number of owners
________________
For each nonresident owner, complete ONLY
Owners
one of these three columns: E, F or G. Please
refer to the instructions for Schedule I.
C
A
B
D
E
F
G
Montana Corporation
Montana Individual
Name
Tax Withheld.
Tax Withheld.
PT-AGR
Identifi cation Number
Ownership
Street Address
Montana Source Income
(Multiply column D
(Multiply column D
or PT-STM
%
(SSN or FEIN)
City | State | Zip Code
by 6.75% and enter
by 6.9% and enter
(Year)
result.)
result.)
1.
SSN
-
-
FEIN
-
00
00
00
2.
SSN
-
-
FEIN
-
00
00
00
Totals
00
00
00
You may use a document with columns ordered as shown above.
*11ED0301*
*11ED0301*
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Parent category: Financial