Form Mrw Reg - Registration For Mineral Royalty Withholding (Mrw)
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3MONTANA
MRW Reg
Rev 05 13
Registration for Mineral Royalty Withholding (MRW)
1. Federal Employer Identifi cation Number
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OR
Social Security Number
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2. Legal Business Name _____________________________________________________________________
3. Doing Business As (DBA) __________________________________________________________________
4. Physical Address ______________________________________________________________________________
City ____________________________________________ State _______________ Zip Code ________________
5. Mailing Address _______________________________________________________________________________
City ____________________________________________ State _______________ Zip Code ________________
6. Contact Person ________________________________
Phone _____________________________ Fax ________________________________
E-mail _________________________________________________________________
7. Legal Entity Type
Sole Proprietor
Partnership
C Corporation
S Corporation
Member Managed LLC
Manager Managed LLC
LLP
Publicly Traded Partnership
Other _______________________________________________________________________________
8. Please provide the following information for the individual owner, if you are a sole proprietor; for all partners, if you
are a partnership; for all corporate offi cers, if you are a corporation; or for all members, if you are a limited liability
company. Use an additional sheet if necessary.
Social Security or Federal
Name
Phone Number
Employer Identifi cation Number
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Parent category: Financial