Montana Form Pt-Agr Draft - Pass-Through Entity Owner Tax Agreement
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4MONTANA
PT-AGR
Rev 01 16
Pass-Through Entity Owner Tax Agreement
15-30-3313, MCA
M M D D Y Y Y Y
M M D D Y Y Y Y
This agreement is valid for the tax year beginning
and ending
, and for all
subsequent tax years until this agreement is revoked.
Part 1 - Pass-Through Entity Information
Entity Name
Federal Employer
-
Identification Number
Mailing Address
City
State
Zip Code
Pass-Through Entity Type:
S corporation
Partnership
Disregarded Entity
Pass-Through Entity Contact Person and Phone Number
Part 2 - Owner Information
Owner/Fiduciary Name
Social Security
Federal Employer
-
-
-
OR
Number
Identification Number
Mailing Address
City
State
Zip Code
Owner Entity Type:
Nonresident Individual
Nonresident Estate
Tax-Exempt Entity
Foreign C corporation
Nonresident Trust
Domestic 2nd Tier Pass-Through Entity
(Complete page 2.)
Part 3 - Agreement and Signature
The undersigned agrees:
•
if an individual, trust or estate, to timely file a return in accordance with the provisions of 15-30-2602, MCA;
•
if a C corporation, to timely file a return in accordance with the provisions of 15-31-111, MCA;
•
if a domestic 2
tier pass-through entity, to timely file a return in accordance with the provisions of 15-30-3302, MCA and establish
nd
that the entity’s distributive share of Montana source income should be fully accounted for in Montana individual income tax returns;
•
to timely pay all taxes imposed with respect to income of the pass-through entity; and
•
to be subject to the personal jurisdiction of the state for the collection of taxes and related interest, penalties and fees imposed with
respect to income of the pass-through entity.
M M D D Y Y Y Y
____________________________________________
_______________________
Signature of Owner/Fiduciary
Date
Phone Number
____________________________________________________________________________________________
If the owner is a foreign C corporation, print name and title of signatory.
Part 4 - Revoke the Agreement
I revoke my previously filed Form PT-AGR as an owner of the entity listed in Part 1 for the following years
______________________
M M D D Y Y Y Y
____________________________________________
_______________________
Signature of Owner/Fiduciary
Date
Phone Number
____________________________________________________________________________________________
If the owner is a foreign C corporation, print name and title of signatory.
*16EA0101*
*16EA0101*
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