Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement printable pdf download

Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement

MONTANA

PT-STM

Rev. 11-04

Second-Tier Pass-Through Entity Owner Statement

Second-tier pass-through entity owner information (as

First-tier pass-through entity information (as shown on

shown on the second-tier owner’s most recent federal return)

the first-tier entity’s most recent federal return or K-1)

Name

Street or other mailing address

City

State

Zip code

City

State

Zip code

Federal Employer Identification Number_________________

Federal Employer Identification Number__________________

Second-Tier Pass-Through Entity Type

First-Tier Pass-Through Entity Type

S. Corporation

Partnership

Disregarded Entity

Information About Second-Tier Entity’s Owners

I. Identity and status (attach additional sheets if necessary)

Name

Address

SSN or FEIN

Status (see instructions on back for codes)

II. Additional information about owners who are nonresident individuals, C. corporations not doing business in

Montana, S. corporations, partnerships and disregarded entities (attach additional sheets if necessary)

Name

Information establishing share (see instructions on back)

I, the undersigned, declare that I am authorized to make this statement on behalf of the second-tier pass-through entity and

that the statement, including all accompanying attachments, is, to the best of my knowledge and belief, true, correct and

complete.

Signature

Title

Date

Questions? Please call the Department of Revenue at (406) 444-6900 or TDD (406) 444-2830.

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Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement