Montana Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement And Waiver Request - 2012
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4MONTANA
CLEAR FORM
Form PT-STM
Rev 08 12
2012 Second-Tier Pass-Through Entity Owner
Statement and Waiver Request
This statement and all accompanying attachments represents information
M M D D Y Y Y Y
M M D D Y Y Y Y
for the tax period from
to
.
First-Tier Pass-Through Entity Information
Name
FEIN
-
Mailing Address
Entity Type Code
City
State
Zip Code + 4
1. Will the fi rst-tier pass-through entity fi le an initial return this year?
Yes
No
2. Will the fi rst-tier pass-through entity fi le a fi nal return this year?
Yes
No
3. What is the original fi ling due date of the fi rst-tier pass-through entity’s return?
M M D D Y Y Y Y
Second-Tier Pass-Through Entity Information
Name
FEIN
-
Mailing Address
Entity Type Code
City
State
Zip Code + 4
1. Will the second-tier pass-through entity fi le an initial return this year?
Yes
No
2. Will the second-tier pass-through entity fi le a fi nal return this year?
Yes
No
3. Will the second-tier pass-through include all of its owners in a composite income tax return?
Yes
No
If the answer is yes, do not complete page 2.
Waiver Request
If a fi rst-tier pass-through entity properly completes Form PT-STM, establishing that the second-tier pass-through entity’s
distributive share of Montana source income will be fully accounted for in Montana corporation license tax or income tax
returns, the requirement to fi le a composite return or pay tax on behalf of the second-tier pass-through entity is waived
on the condition that the fi rst-tier entity agrees to pay amounts that should have been remitted within 60 days after notice
from the department that all Montana returns were not fi led or all Montana taxes have not been paid.
Is a multiple year waiver request letter included with the Form PT-STM?
Yes
No
First-Tier Entity Signature
I, the undersigned, declare under penalty of false swearing, that I am authorized to make this statement and request this
waiver on behalf of the fi rst-tier pass-through entity, and that the statement, including all accompanying attachments, is, to
the best of my knowledge and belief, true, correct and complete.
__________________________________________
_______________________________
___________________
Signature
Title
Date
Indicate the number of pages included with the Form PT-STM (including this page).
*12EB0101*
*12EB0101*
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