Form Cr-T - Application For Tax Certificate
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1
2MONTANA
Clear Form
CR-T
Rev 04 12
Application for Tax Certifi cate
1.
Entity Information
Entity Name
Entity Contact Person and Phone Number (Required)
Mailing Address
City
State
Zip Code
Federal Employer
Secretary of State
-
Identifi cation Number
Identifi cation Number
2.
Representative Information (Person to whom the certifi cate should be sent.)
Name
Mailing Address
City
State
Zip Code
3.
Type of Certifi cate Requested (Mark each type of certifi cate requested.)
Title 15
Dissolution/
Good Standing
Tax Clearance
Reviver
Reinstate with
Withdrawal
Show that your tax
Verify that your fi nal
Reinstate with the Secretary of State
the Secretary of
Withdraw/dissolve
fi ling and payment
return was fi led and
after being suspended (You must
State after being
with the Secretary of
requirements are
all taxes have been
also request a Title 15 Certifi cate.)
involuntarily dissolved
State
current
paid
4.
Business Entity Types (Mark only one box.)
C corporation
Disregarded entity (other than a sole proprietorship)
S corporation
LLC taxed as a partnership
Partnership
LLC taxed as an S corporation
Limited liability partnership
LLC taxed as a C corporation
Trust
Nonprofi t (tax exempt) organization (see instructions)
Sole proprietorship (including LLCs
taxed as a sole proprietorship)
-
-
Name of sole proprietor ______________________________________ SSN of sole proprietor
5.
For C Corporations Only
a.
If merging or consolidating, provide the name and FEIN for the surviving entity and the date of merger/consolidation.
Name of the surviving entity ______________________________________________________________________
-
FEIN of the surviving entity
Date of merger or consolidation ________________________
b.
If you are fi ling a combined Montana tax return, enter the name and FEIN as shown on the tax return.
-
Name _______________________________________________________________
FEIN
You must provide a completed Form ATL (Assumption of Tax Liability) if your C corporation completed question 5a and/or 5b.
6.
Signature
________________________________________________
____________________________________________
Print Name
Title
______________________________________________________________
_______________________________
Signature
Date
Mail application to: Montana Department of Revenue; Attn: Certifi cates; PO Box 5805; Helena, MT 59604-5805
Fax application to: (406) 444-6642
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