Fillable Form Telc - Temporary Emergency Lodging Credit

Form Telc - Temporary Emergency Lodging Credit - 2012

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MONTANA

Clear Form

TELC

Rev 02 12

2012 Temporary Emergency Lodging Credit

15-30-2381 and 15-31-171, MCA

Name (as it appears on your Montana tax return)

Social Security

Federal Employer

X X X X X X X X X

Number

Identification Number

Part I. Partners in a Partnership or Shareholders of an S Corporation

Enter your portion of the temporary emergency lodging credit here. See instructions.

$_____________________

Business Name of Partnership or S Corporation

Federal Employer

Identification Number

___________________________________________________

Part II. Credit Computation

Public Accommodation License Number _________________________________________________________

(Provided by the Department of Health and Human Services)

Please complete the following for each individual referred for lodging in Montana.

Column A

Column B

Column C

Column D

Column E

Column F

Number

of rooms

Number of

Multiply the

provided

Allowable

nights of

(Count each

amounts in

Columns C, D

lodging

room only

credit

Name of designated charitable

Date(s) of lodging

once, even

(maximum of

per night

and E

organization referring individual(s)

if more than

5 nights per

(C x D x E)

per room

individual

one person

occupied

and enter the

occupied the

per calendar

result here.

year)

room on the

dates listed

in Column B.)

$30

10.

$30

11. Enter the total of Column F here. This is your Temporary Emergency Lodging Credit. ..........11.

Where to Report Your Credit

► Individuals: Form 2, Schedule V

► S corporations: Form CLT-4S, Schedule II

► C corporations: Form CLT-4, Schedule C

► Partnerships: Form PR-1, Schedule II

If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you file electronically, you

represent that you have retained the required documents in your tax records and will provide them upon the department’s request.

*12JF0101*