Form 4361 - Application For Exemption From Self-Employment Tax For Use By Ministers, Members Of Religious Orders And Christian Science Practitioners

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4361
Application for Exemption From Self-Employment Tax
OMB No. 1545-0074
Form
for Use by Ministers, Members of Religious Orders
File Original
(Rev. January 2011)
and Christian Science Practitioners
Department of the Treasury
and Two Copies
Internal Revenue Service
File original and two copies and attach supporting documents. This exemption is granted only if the IRS returns a copy to you marked “approved.”
1 Name of taxpayer applying for exemption (as shown on Form 1040)
Social security number
Number and street (including apt. no.)
Telephone number (optional)
City or town, state, and ZIP code
3
Date ordained, licensed, etc.
2 Check one box:
Christian Science practitioner
Ordained minister, priest, rabbi
(Attach supporting document.
Member of religious order not under a vow of poverty
Commissioned or licensed minister (see line 6)
See instructions.)
4 Legal name of ordaining, licensing, or commissioning body or religious order
Number, street, and room or suite no.
Employer identification number
City or town, state, and ZIP code
5 Enter the first 2 years after the date shown on line 3 that you had net self-employment earnings of $400 or
more, any of which came from services as a minister, priest, rabbi, etc.; member of a religious order; or
Christian Science practitioner
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6 If you apply for the exemption as a licensed or commissioned minister and your denomination also ordains ministers, please indicate how your
ecclesiastical powers differ from those of an ordained minister of your denomination. Attach a copy of your denomination’s bylaws relating to the
powers of ordained, commissioned, and licensed ministers.
7 I certify that I am conscientiously opposed to, or because of my religious principles I am opposed to, the acceptance (for services I perform as a
minister, member of a religious order not under a vow of poverty, or Christian Science practitioner) of any public insurance that makes payments in
the event of death, disability, old age, or retirement; or that makes payments toward the cost of, or provides services for, medical care. (Public
insurance includes insurance systems established by the Social Security Act.)
I certify that as a duly ordained, commissioned, or licensed minister of a church or a member of a religious order not under a vow of poverty, I have
informed the ordaining, commissioning, or licensing body of my church or order that I am conscientiously opposed to, or because of religious
principles I am opposed to, the acceptance (for services I perform as a minister or as a member of a religious order) of any public insurance that
makes payments in the event of death, disability, old age, or retirement; or that makes payments toward the cost of, or provides services for,
medical care, including the benefits of any insurance system established by the Social Security Act.
I certify that I have never filed Form 2031 to revoke a previous exemption from social security coverage on earnings as a minister, member of a
religious order not under a vow of poverty, or Christian Science practitioner.
I request to be exempted from paying self-employment tax on my earnings from services as a minister, member of a religious order not under a
vow of poverty, or Christian Science practitioner, under section 1402(e) of the Internal Revenue Code. I understand that the exemption, if granted,
will apply only to these earnings. Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and
belief, it is true and correct.
Signature
Date
Caution: Form 4361 is not proof of the right to an exemption from federal income tax withholding or social security tax, the right to a parsonage
allowance exclusion (section 107 of the Internal Revenue Code), assignment by your religious superiors to a particular job, or the exemption or church
status of the ordaining, licensing, or commissioning body, or religious order.
For Internal Revenue Service Use
Approved for exemption from self-employment tax on ministerial earnings
Disapproved for exemption from self-employment tax on ministerial earnings
By
(Director’s signature)
(Date)
General Instructions
Note. If you are a commissioned or licensed
death, disability, old age, or retirement; or that
minister of a religious denomination or church
makes payments for the cost of, or provides
Section references are to the Internal Revenue
that ordains its ministers, you may be treated in
services for, medical care, including any
Code unless otherwise noted.
the same manner as an ordained minister if you
insurance benefits established by the Social
perform substantially all the religious functions
Security Act.
Purpose of form. File Form 4361 to apply for an
within the scope of the tenets and practices of
exemption from self-employment tax if you have
If you are a duly ordained, commissioned, or
your religious denomination or church.
ministerial earnings (defined later) and are:
licensed minister of a church or a member of a
religious order not under a vow of poverty, prior
This application must be based on your
• An ordained, commissioned, or licensed
to filing this form you must inform the ordaining,
religious or conscientious opposition to the
minister of a church;
commissioning, or licensing body of your church
acceptance (for services performed as a
• A member of a religious order who has not
or order that, on religious or conscientious
minister, member of a religious order not under a
taken a vow of poverty; or
grounds, you are opposed to the acceptance of
vow of poverty, or Christian Science practitioner)
• A Christian Science practitioner.
public insurance benefits based on ministerial
of any public insurance that makes payments for
service.
4361
For Privacy Act and Paperwork Reduction Act Notice, see page 2
Form
(Rev. 1-2011)
Cat. No. 41586H

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