Form Etm - Enrolled Tribal Member Exempt Income Certification/return - 2013 Page 2
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1
2Form ETM Instructions
follows:
New! You no longer have to fi le a Montana income tax return
●
(Form 2) if you are a tribal member and all of your income is
$4,180 if your fi ling status is single or married fi ling
exempt from Montana income tax. Form IND, Tribal Member
separately ($6,460 if you are 65 or older)
Certifi cation, has been replaced with this form which will
●
$6,080 if your fi ling status is head of a household
serve as your return.
($8,360 if you are 65 or older)
If only part of your income is exempt from Montana income
●
$8,360 if your fi ling status is married fi ling jointly with
tax, you will need to include this form with Montana Form 2.
your spouse ($10,640 if you or your spouse is 65 or
older and $12,920 if both spouses are 65 or older)
Heading
The fi ling threshold is increased by $2,280 if an individual is
blind.
Print your name, mailing address, physical address(es) and
social security number in the spaces provided. If you lived at
Line 3 – Complete the exempt income information table.
more than two addresses during the year, include a separate
Provide the name of your employer(s) or the source of your
sheet listing the locations and dates. Also include the name of
exempt income. If you are self-employed, enter your business
the Montana tribe of which you are an enrolled member and
name.
your tribal enrollment number.
If you are not self-employed, enter the FEIN of your employer.
Line 1 – Please check “Yes” if you resided on the reservation
If you are a wage earner, this information will be available on
where you are an enrolled member for the entire year. Check
the federal Form W-2 you received from your employer.
“No” if you resided off the reservation where you are an
enrolled member at any time during the year.
Enter the physical address where the wages were earned
or services provided and the dates work was performed. If
Line 2 – Check the box next to the statement that is true. The
necessary, attach a sheet listing additional income claimed as
fi rst box should be marked if either of the following applies
exempt.
to you: (1) all of your income is exempt, or (2) you had both
exempt and non-exempt income but the non-exempt amount
Signature Block
did not exceed the fi ling threshold for your age and fi ling
This is not considered a valid certifi cation or return unless
status.
you sign it. If you are fi ling electronically, the act of fi ling
Also, check this box and submit it with Form 2 in order to
electronically signifi es your declaration, under the penalty of
request a refund of any Montana tax withheld or payments you
false swearing, that:
made.
●
You are the taxpayer identifi ed on the form; and
The second box should be marked if you had both exempt and
●
The information in the claim is true, correct and
non-exempt income and your non-exempt income exceeded
complete.
the applicable fi ling status. If this is the case, you are required
to fi le Form 2 to pay Montana income tax on the non-exempt
Your fi ling electronically, with this declaration, is your
portion of your income.
signature.
Income is exempt from Montana income tax if all of the
If you want to allow your preparer, a friend, a family member
following requirements are met:
or any other person you choose to discuss this form with the
department, mark the “Yes” box in the Third Party Designee
●
You are an enrolled tribal member of the governing
section of the signature block. You must also enter the
tribe of a reservation;
designee’s printed name and phone number. If you do not
●
You resided and worked on that reservation; and
complete this section in its entirety, we cannot discuss this
form with a third party.
●
You earned the income by working on that
reservation.
If you choose not to fi le electronically and you are not required
to fi le Montana Form 2, please mail your Form ETM to:
The following income is not exempt from Montana income tax:
Montana Department of Revenue
●
Income you earn from working on a reservation
PO Box 6577
where you are not an enrolled tribal member of the
Helena, MT 59604-6577
governing tribe.
Administrative Rules of Montana: 42.15.220
●
Income you earn from working outside the reservation
where you are an enrolled member, including income
Questions? For additional information regarding the taxation
you earned in another state.
of Native Americans or the third party designation, please visit
our website at revenue.mt.gov. You may also call us toll free at
●
Income earned while you are not residing on the
(866) 859-2254 (in Helena, 444-6900).
reservation where you are an enrolled member.
You are required to fi le Form 2 if your non-exempt income
exceeds the fi ling threshold. The threshold for fi ling depends
on your fi ling status. For 2013, the fi ling thresholds are as
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