Montana Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement And Waiver Request Page 2

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Form PT-STM, Page 2
FEIN
-
Pass-Through Entity Owner Information (List the owners of the second-tier, third-tier, etc.)
Name
Residency
Will this owner fi le a
FEIN of the entity that this
Entity Type and Identifi cation
Street Address or PO Box
Code
Composite
MT tax return for the
owner has an ownership
Number (FEIN or SSN)
City | State | Zip Code
(R/N)
current tax year?
interest in
1
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
2
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
3
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
4
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
5
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
6
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
7
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
SSN
_________% of ownership
8
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
SSN
_________% of ownership
9
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
SSN
_________% of ownership
10
Entity Type
R
Yes
Yes
-
FEIN
No
N
No
Don’t Know
_________% of ownership
SSN
*13EB0201*
*13EB0201*

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