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MONTANA

CLT-4X

Rev. 8-02

Amended Montana Corporation License Tax Return

For calendar year _________ or other taxable year beginning _________________, and ending _________________

Name

FEIN:

Number and Street or P.O. Box

If new address check here

City or Town, State, and Zip Code

Important: Please read specific instructions pertaining to refunds on back of this form.

a. As Originally

b. Net Changes

c. Correct

reported or as adjusted

increase or decrease

Amount

1. Montana Taxable Income......................................

Tax Liability

2. Tax Liability - 6.75% of line 1, but not less than $50

(Small Business Corporations $10)........................

3. Surtax (see back of this form)...............................

4. Add: Investment Tax Credit Recapture*..................

5. Less: Allowable Tax Credits*.................................

6. Adjusted Tax Liability............................................

7. Less: Total Tax Paid (original plus subsequent payments)..........................................

[

]

8. Plus: Previous Refunds Issued................................................................................

9. Tax Due (Overpayment)..........................................................................................

10.Add Interest (see rules on back)..............................................................................

11. Total Due or (Overpayment Due) (total of lines 9 and 10)..........................................

*attach a schedule if recapture or credit is different from the amount originally reported

Please check or indicate reasons for amending return:

NOL carryback/carryforward; year of loss___________________________

Federal Revenue Agent Report -

copy of this report is required

Factor Changes -

complete back of this form, a detailed explanation of changes to factors is required.

Amended Federal Return (Form 1120X) -

a copy of the complete 1120X is required.

Other -

Explain in detail on the back of this form

For changes to credits attach applicable schedules and the reason for the change.

Declaration

I, the undersigned officer of the corporation for which this return is made, hereby declares that this return, including all accompanying

schedules and statements is, to the best of my knowledge and belief, a true, correct, and complete return, made in good faith for the

income period stated, pursuant to the Montana Corporation License Tax laws and regulations.

Signature of Officer

Date

Name of person or firm preparing return

Date

Title

Address and Zip Code

Telephone #

206

Form Clt-4x - Amended Montana Corporation License Tax Return With Instructions - 2002

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