Form Etm - Enrolled Tribal Member Exempt Income Certification/return - 2013
Download a blank fillable Form Etm - Enrolled Tribal Member Exempt Income Certification/return - 2013 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Etm - Enrolled Tribal Member Exempt Income Certification/return - 2013 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2MONTANA
CLEAR FORM
ETM
Rev 08 13
2013 Enrolled Tribal Member
Exempt Income Certifi cation/Return
First Name and Initial
Last Name
Social Security Number
-
-
Mailing Address
City
State
Zip Code
Physical Address (not a post offi ce box)
City
State
Dates
Physical Address (if you moved during the year)
City
State
Dates
Montana Tribe (of which you are an enrolled member)
Tribal Enrollment Number
1.
Did you reside on the reservation where you are an enrolled member?
Yes
No
2.
Please check the statement that is true. Check only one.
All of my income is exempt from Montana income tax; or I had both exempt and nonexempt income, but my non-exempt
income was not enough to require that I fi le a Montana income tax return (Form 2).
Part of my income for the year was exempt from Montana income tax, but I did have other non-exempt income that exceeds
the Montana fi ling threshold. I am including this form with my completed Montana Form 2.
3.
Enter your exempt income information in the table below.
Employer’s Name (or source of exempt income)
Employer Federal Employer
Income Type (wages,
Street Address, City, State and Zip (not a PO
Dates
Identifi cation Number (FEIN)
interest, etc.)
Box)
M M D D Y Y Y Y
From
-
M M D D Y Y Y Y
To
M M D D Y Y Y Y
From
-
M M D D Y Y Y Y
To
M M D D Y Y Y Y
From
-
M M D D Y Y Y Y
To
I declare under penalty of false swearing that I am an enrolled member of the tribe identifi ed above, that I possess the full rights
of tribal membership, that I reside on the reservation identifi ed above and all the information on this form and included with this
form is true, correct and complete.
*13DK0101*
Your Signature is Required
Date
Daytime Telephone Number
*13DK0101*
X
Paid Preparer’s Signature
Paid Preparer’s PTIN/SSN
Firm’s FEIN
Third Party Designee
Third Party Designee’s Printed Name
Do you want to allow another person (such as a paid
preparer) to discuss this return with us?
Third Party Designee’s Phone Number
Yes
No
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial