MONTANA
CLEAR FORM
FTB
Rev 03 13
2013 Montana First-time Home Buyer Savings Account
Annual Reporting Information for Self-administered Accounts
15-63-101 through 15-63-205, MCA
First Name and Initial
Last Name
Social Security Number
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Name and address of the fi nancial institution where your Montana fi rst-time home buyer savings account is established:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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Your Montana fi rst-time home buyer savings account number
Part I. Allowable exclusion calculation
1. Current year deposits (Column A if using FTB-Worksheet) ........................ 1.
2. Deposits from prior years not previously excluded ..................................... 2.
3. Add lines 1 and 2 ........................................................................................ 3.
4. Enter the lesser of the amount on line 3 or $3,000...................................................................4.
5. Interest and other income (Column B if using FTB-Worksheet) ...............................................5.
6. Add lines 4 and 5. This is your Montana First-time Home Buyer Savings Account exclusion.
Enter this amount on Form 2, Schedule II, line 19 ...................................................................6.
7. If the amount on line 3 is greater than $3,000, subtract line 4 from line 3.
These are your excess deposits that may be excluded next year ............................................7.
Part II. Nonqualifi ed withdrawals
1. Nonqualifi ed withdrawals (Column D if using FTB-Worksheet) ................................................1.
Enter this amount on Form 2, Schedule I, line 8.
2. Enter the withdrawals on line 1 made on the last business day in 2013 ..................................2.
3. Subtract line 2 from line 1 .........................................................................................................3.
4. Multiply the amount on line 3 by 10% (0.10). Enter this amount on Form 2, line 68 and write
“FTB” in the space provided. This is your penalty ....................................................................4.
The Montana First-time Home Buyer Savings Account Worksheet (FTB-Worksheet) is available to help you reconcile the
activity on this form by providing a log to track deposits, withdrawals, fees and other transactions. It is not required to be
completed or included with your tax return. (The FTB-Worksheet follows the instructions for this form.)
If you fi le your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you fi le electronically, you
represent that you have retained the required documents in your tax records and will provide them upon the department’s request.
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