Form Pte-Nroa - Idaho Nonresident Owner Agreement

Form Pte-Nroa - Idaho Nonresident Owner Agreement - 2015

2015

PTE-NROA

IDAHO NONRESIDENT OWNER AGREEMENT

EFO00263-1

07-10-15

NONRESIDENT OWNER INFORMATION

Name of nonresident owner

Social Security number

Current mailing address

ZIP code

Phone number

City

State

Agreement to file

I agree to timely file all required Idaho income tax return(s) and to make timely payments of all taxes imposed by the

state of Idaho with respect to my share of the Idaho income of the pass-through entity (entity) named below. I agree

that I am subject to the jurisdiction of the state of Idaho for purposes of the collection of unpaid income tax, together

with related penalties and interest. This form is not valid without the approval of the entity as indicated by the signature

below.

Signature

Owner's signature

Date

PASS-THROUGH ENTITY INFORMATION

Name of pass-through entity

Federal EIN

Current mailing address

ZIP code

Phone number

City

State

Pass-through Entity Acknowledgment and Approval

By signing below, the above named pass-through entity acknowledges that Idaho Code section 63-3022L(4) authorizes

the Idaho State Tax Commission to assess and collect any tax due from the entity when a nonresident owner fails to

abide by the terms of this agreement.

Title

Authorized agent's name (please print)

Authorized agent's signature

Date

Form Pte-Nroa - Idaho Nonresident Owner Agreement - 2015