No
Clear Form
Staples
D
2012 Montana Disregarded Entity Information Return
Form DER-1
For calendar year 2012 or tax year beginning
and ending
M M D D 2 0 1 2
M M D D Y Y Y Y
Name
Mark if
Social Security Number
applicable.
-
-
Initial Return
Address
OR
Federal Employer
Identifi cation Number
Final Return
City
State Zip + 4
-
Amended
Mark this box if this FEIN
or SSN is the same as the
owner’s FEIN or SSN.
1. Enter any assumed business name under which the entity does business in Montana
______________________
M M D D Y Y Y Y
2. Domestic entities: the date the entity was incorporated or formed in Montana ...............
3. Foreign entities: the date the entity obtained a certifi cate of authority from the Montana
M M D D Y Y Y Y
Secretary of State ............................................................................................................
4. Montana Secretary of State ID # .....................................................................................
5. State or country where the entity was incorporated or formed ........................................
_____________________
6. Disregarded Entity Type (Mark appropriate entity type. See instructions for the correct box to mark.)
A.
Single Member Limited Liability Company
Estate
(SMLLC)
Real Estate Investment Trust (REIT)
Mark only one single member limited liability
company owner type.
Any other single member not described
above
Individual (The Montana Form DER-1 is
not required to be fi led if the SMLLC is
Partnership
owned by an individual who has been
Electing IRC § 761 Partnership
a full-year Montana resident during the
applicable reporting period.)
Real Estate Mortgage Investment Conduit
(REMIC)
S corporation
Non-Grantor Trust
Qualifi ed Subchapter S Subsidiary
Qualifi ed REIT Subsidiary
C corporation
B.
Entity Type Other than SMLLC
M M D D Y Y Y Y
IRC § 761 Partnership. Enter date of election ..................................................
M M D D Y Y Y Y
IRC § 1361(b)(3) Qualifi ed Subchapter S Subsidiary. Enter date of election ...
IRC § 856(i)(2) Qualifi ed Real Estate Investment Trust Subsidiary.
IRC § 860D Real Estate Mortgage Investment Conduit (REMIC). Include a copy of federal Form 1066.
*12ED0101*
*12ED0101*