Montana Form Telc - Temporary Emergency Lodging Credit - 2012
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MONTANA
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TELC
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Rev 02 12
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2012 Temporary Emergency Lodging Credit
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15-30-2381 and 15-31-171, MCA
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Name (as it appears on your Montana tax return)
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Social Security
Federal Employer
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-
-
X X X X X X X X X
X X X X X X X X X
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OR
Number
Identification Number
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Part I. Partners in a Partnership or Shareholders of an S Corporation
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Enter your portion of the temporary emergency lodging credit here. See instructions.
$_____________________
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Business Name of Partnership or S Corporation
Federal Employer
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Identification Number
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___________________________________________________
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Part II. Credit Computation
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Public Accommodation License Number _________________________________________________________
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(Provided by the Department of Health and Human Services)
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Please complete the following for each individual referred for lodging in Montana.
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Column A
Column B
Column C
Column D
Column E
Column F
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Number
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of rooms
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Number of
Multiply the
provided
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nights of
Allowable
amounts in
(Count each
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lodging
room only
credit
Columns C, D
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Name of designated charitable
(maximum of
once, even
Date(s) of lodging
per night
and E
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organization referring individual(s)
if more than
5 nights per
per room
(C x D x E)
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one person
individual
occupied
and enter the
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occupied the
per calendar
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result here.
year)
room on the
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dates listed
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in Column B.)
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1.
$30
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2.
$30
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3.
$30
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$30
4.
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$30
5.
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$30
6.
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7.
$30
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8.
$30
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9.
$30
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10.
$30
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11. Enter the total of Column F here. This is your Temporary Emergency Lodging Credit. ..........11.
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Where to Report Your Credit
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► Individuals: Form 2, Schedule V
► S corporations: Form CLT-4S, Schedule II
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► C corporations: Form CLT-4, Schedule C
► Partnerships: Form PR-1, Schedule II
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If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you file electronically, you
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represent that you have retained the required documents in your tax records and will provide them upon the department’s request.
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*12JF0101*
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*12JF0101*
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