Form Clt-4s - Montana S Corporation Information And Composite Tax Return - 2012 Page 5

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Form CLT-4S, Page 5
FEIN
-
Schedule III – Montana S Corporation Information
Summary Schedule and Supplemental Information
Complete columns E, F or G if the shareholder is
a nonresident individual, estate, trust or foreign C
Complete columns A through D for all shareholders.
corporation. If electing composite tax, mark column E.
A
B
C
D
E
F
G
Name
Entity Type and
Composite Income Tax
Shareholder
Residency
Ownership
PT-AGR
Street Address or PO Box
Identifi cation Number (FEIN or SSN)
(from Schedule IV,
Withholding (see
Code (R/N)
%
(year)
City | State | Zip Code
(see codes below*)
column H)
instructions)
1.
Entity Type
R
FEIN
N
00
00
SSN
2.
Entity Type
R
FEIN
N
00
00
SSN
3.
Entity Type
R
FEIN
N
00
00
SSN
4.
Entity Type
R
FEIN
N
00
00
SSN
5.
Entity Type
R
FEIN
N
00
00
SSN
6.
Entity Type
R
FEIN
N
00
00
SSN
7.
Entity Type
R
FEIN
N
00
00
SSN
8. Enter the totals of columns D, E and F from all additional pages, if used ...............................................
00
00
Enter the totals of columns D, E and F ........................................................................................................
00
00
Transfer the total from column E to Form CLT-4S, line 21. Transfer the total from column F to Form CLT-4S, line 22.
Include all additional pages from line 8 with the tax return.
*Column B Entity Type Codes:
C – C corporation
E – Estate
F – Foreign C corporation
I – Individual
T – Trust
*12DX0501*
*12DX0501*

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