Form Pte-Nro - Idaho Nonresident Owner Agreement - 2013

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2013
F
Pte-NRoa
Idaho NoNResIdeNt owNeR agReemeNt
O
R
EFO00263
M
07-11-13
NoNResIdeNt owNeR INFoRmatIoN
Name of nonresident owner
Social Security Number
Street or mailing address
ZIP Code
Telephone number
City
State
Agreement to file
I agree to timely file all required Idaho income tax return(s) and to make timely payments of all taxes imposed by the
state of Idaho with respect to my share of the Idaho income of the pass-through entity (PTE) named below. I agree that
I am subject to the jurisdiction of the state of Idaho for purposes of the collection of unpaid income tax, together with
related penalties and interest. This form is not valid without the approval of the PTE as indicated by the signature below.
signature
Taxpayer's signature
Date
Pass-thRoUgh eNtItY INFoRmatIoN
Name of pass-through entity (PTE)
Federal EIN
Street or mailing address
ZIP Code
Telephone number
City
State
Pass-through Entity Acknowledgment and Approval
By signing below, the above named pass-through entity acknowledges that Idaho Code section 63-3022L(4) authorizes
the Idaho State Tax Commission to assess and collect any tax due when a nonresident owner fails to abide by the terms
of this agreement.
Title
Authorized agent's name (Please print)
Authorized agent's signature
Date

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