Montana Form Telc - Temporary Emergency Lodging Credit - 2010
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MONTANA
TELC
Rev. 08 10
2010 Temporary Emergency Lodging Credit
15-30-2381 and 15-31-171, MCA
Name (as it appears on your tax return) ______________________________________________________
Social Security Number or Federal Employer Identifi cation Number
Public Accommodation License Number _________________________________________________
(Provided by the Department of Health and Human Services)
If this credit is passed through to you from a partnership or S corporation, enter the entity’s name, FEIN
and the percentage used to report the corporation’s or partnership’s income or loss for Montana income tax
purposes.
Name _______________________________ FEIN ______________________ Percentage ________ %
Please complete the following for each individual referred for lodging in Montana:
Column A
Column B
Column C
Column D
Column E
Multiply the
Number of
amount in
Allowable
Nights of
Column C by
Name of Designated Charitable
Date(s) of Lodging
Credit Per
Lodging
the amount in
Organization Referring Individual
Night
(Maximum of
Column D and
5 nights)
enter result
here.
1.
$30
2.
$30
3.
$30
4.
$30
5.
$30
6.
$30
7.
$30
8.
$30
9.
$30
10.
$30
11. Enter the total of Column E here. This is your Temporary Emergency Lodging
Credit. .......................................................................................................................... 11.
Enter the total of Column E on your respective form:
► Form 2, Schedule V for individuals
► Form CLT-4, Schedule C for C corporations
► Form CLT-4S, Schedule II for S corporations
► Form PR-1, Schedule II for Partnerships
When you fi le your Montana income tax return electronically, you represent that you have retained all documents required as a tax record and that you
will provide a copy to the department upon request. If you fi le electronically, you do not need to mail this form to us unless we contact you for a copy.
*30180101*
3018
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