Form Ina-Ct - Affidavit Of Inactivity For Corporations
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1
2MONTANA
Clear Form
INA-CT
Rev 03 12
Affi davit of Inactivity for Corporations
Part I. Qualifi cations.
Please mark the appropriate box for each question.
1. Do you have any type of income (sales, gains, etc.) from sources in Montana?
Yes
No
2. Do you have any employees or other representatives who perform work in Montana?
Yes
No
3. Do you have any property or rents in Montana?
Yes
No
4. Did you receive any distributive share of Montana source items from a pass-through entity?
Yes
No
If you answered yes to any of the above questions, you do not qualify for this form and must submit an applicable Montana return.
Part II. Return Type.
Please mark the box for the type of your entity.
C corporation
S corporation
Part III. Entity Information
1. Corporation’s Name
2. Street Address
3. City/State/ZIP
4. Federal Employer Identifi cation Number
5. Tax Period End Date
6. Contact Person
7. Contact Phone
Part IV. Affi davit and Signature
In the State of ___________________________________ , in the county of ___________________________________________ ,
I, _____________________________________________ , being sworn on oath, depose and say that I am an authorized
representative of the designated entity, that I am acquainted with the affairs of the entity and that the entity had no income or business
activity of any nature in Montana for the tax period indicated in Part III, question 5 above.
For C corporations, I understand that each tax period the entity is either required to fi le an Affi davit of Inactivity or, if the entity does
engage in business or have any income, notify the department by fi ling a Montana Corporation License Tax Return by the due date
prescribed in 15-31-111, MCA.
For S corporations, I understand that each tax period the entity is either required to fi le an Affi davit of Inactivity or, if the entity does
engage in business or have any income, notify the department by fi ling a Montana S-Corporation Information and Composite Tax
Return by the due date prescribed in 15-30-3302, MCA.
______________________________________________
______________________________________________
Signature of Authorized Representative
Date
______________________________________________
______________________________________________
Print Name of Authorized Representative
Title of Authorized Representative
This affi davit was signed and sworn to before me
on __________________________________________ , 20 ______ ,
by _____________________________________________ (name) as
________________________ (title) of __________________ (entity)
Title and Rank
(SEAL)
________________________________________________________
(Signature of Notarial Offi cer)
____________________________ , Residing at _________________
(Name)
(City and State)
My Commission Expires ____________________________________
(Month, Day and Four Digit Year)
Please return completed form to: Montana Department of Revenue, PO Box 5805, Helena, MT 59604-5805
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