Form Pw-2 - Wisconsin Nonresident Partner, Member, Shareholder, Or Beneficiary Withholding Exemption Affidavit - 2015 Page 2
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1
2PW-2
Form
Wisconsin Nonresident Partner,
2015
Member, Shareholder, or Beneficiary
Part 2
Withholding Exemption Affidavit
Part 2: Information for Department of Revenue and Pass-Through Entity
Agreement to File, Routing, Declaration, and Signature
I,
, as a nonresident partner, member, shareholder, or beneficiary of the
pass-through entity
, request this pass-through entity to be exempt from
the Wisconsin income or franchise tax withholding requirement found in sec. 71.775, Wis. Stats., for my tax year ending
.
By signing this affidavit I agree to timely file a Wisconsin income or franchise tax return for my tax year shown above.
I agree to be subject to the personal jurisdiction of the Wisconsin Department of Revenue, the Wisconsin Tax Appeals
Commission, and the courts of this state for the purpose of determining and collecting any Wisconsin taxes, including
estimated tax payments, together with any interest and penalties.
Third
Do you want to allow another person to discuss this return with the department?
Yes
No
Complete the following.
Party
Personal
Designee’s
Phone
identification
(
)
Designee
name
no.
number (PIN)
I declare that the information provided in this affidavit is complete and accurate, and that I meet all requirements of the exemption
checked in Part 1. I understand that the Department will return Part 2 of this form to me. I further understand that approval of this
affidavit does not constitute an audit by the Department, and that the Department’s determination regarding approval of this affidavit
may not be appealed.
Title (if applicable)
Taxpayer’s Signature
Date
The Department will return this form by mail. Enter address information below. Please type or print legibly.
To Attention of
Company Name (if applicable)
Number and Street
City
State
ZIP Code
Return to Page 1
Approval by Department of Revenue
Approved for 2015 Taxable Year
Not Approved
Reviewer’s Initials
Date
Send Parts 1 and 2 of this form to the Wisconsin Department of Revenue at:
(Use cover page provided with instructions)
Fax:
Wisconsin Department of Revenue
Mail:
BTS/PTE, Mail Stop 3-107
PO Box 8958
Madison, WI 53708-8958
The Department will return Part 2 of Form PW-2 to you within approximately 30 days of receiving it. If the Department has
approved Form PW-2, provide this page to the pass-through entity. The pass-through entity must keep a copy of this page
for its records as documentation showing why it did not pay withholding tax on your behalf.
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