Form Clt-4 - Montana Corporation License Tax Return - 2012 Page 4
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4M M D D Y Y Y Y
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Form CLT-4, Page 4
Period End Date
FEIN
Computation of Montana Taxable Income and Net Amount Due (continued)
11. Your Montana tax liability from line 10 ............................................................................................................11.
00
12. Payments
12a. 2011 overpayment ..................................................................................................... 12a.
00
12b. Tentative payment ..................................................................................................... 12b.
00
12c. Quarterly estimated tax payments ............................................................................. 12c.
00
12d. Montana mineral royalty tax withheld (include Form(s) 1099) ................................... 12d.
00
12e. Montana tax withheld from pass-through entities (include MT Schedule(s) K-1) ...... 12e.
00
12f. All other payments. Describe
____________________________________
............. 12f.
00
12g. Previously issued refunds. (Do not include any overpayments to 2013.) .................. 12g.
00
Add lines 12a through 12f and subtract line 12g; enter the result. This is the total of your payments. ..... 12.
00
13. Enter total credits (from Schedule C) ............................................................................................................ 13.
00
14. Add lines 12 and 13, then subtract from line 11 and enter result. This is your tax due or overpayment. ... 14.
00
15. Enter the amount of overpayment that you want to be applied to your 2013 estimated tax .......................... 15.
00
16. Add lines 14 and 15; enter the result. This is your net tax due or overpayment....................................... 16.
00
17. Enter interest on all the tax paid after the due date, calculated at 12% per year, on a daily basis ............... 17.
00
18. Enter estimated tax underpayment interest (include Form CLT-4-UT) .......................................................... 18.
00
Mark this box if you are using the annualized income or adjusted seasonal income method.
19. Penalty
19a. Enter your late fi ling penalty (see instructions) .......................................................... 19a.
00
19b. Enter your late payment penalty (see instructions) ................................................... 19b.
00
Add lines 19a and 19b; enter the result. This is your total penalty. ............................................................ 19.
00
20. Add lines 16 through 19; enter the result on line 20a or 20b below.
20a. If the result is positive, enter the amount due here. This is your total amount due. ................................ 20a.
00
Include your remittance payable to Montana Department of Revenue or visit our website at revenue.mt.gov for electronic payment options.
20b. If the result is negative, enter the refund due here. This is your total refund. .......................................... 20b.
00
For Direct Deposit of
1. RTN#
2. ACCT#
your refund, complete
3. If using direct deposit, you are required to mark one box. ►
Checking
Savings
1, 2, 3 and 4. Please
see instructions on
4. Is this refund going to an account that is located outside of the United States or its territories?
Yes
No
page 6.
Paid preparer information. Please print.
Please mail your completed
Form CLT-4 to:
Name
May the DOR discuss
this return with your
MT Department of Revenue
Address
tax preparer?*
PO Box 8021
Telephone Number
Helena, MT 59604-8021
(See instructions.)
Contact’s Name
Yes
No
PTIN, SSN or FEIN
Date
*If you would like to authorize a representative to discuss tax matters with the department, you must complete a Power of Attorney form.
This form is available on our website at revenue.mt.gov under Forms and Resources.
Declaration - Under penalties of false swearing, I declare that I have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature of Offi cer
Date
Telephone Number
X
Printed Name of Offi cer
Title
*12EP0401*
*12EP0401*
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