Montana Form Pt-Stm - Second-Tier Pass-Through Entity Owner Statement And Waiver Request (For Tax Years 2011 And Earlier)

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MONTANA
CLEAR FORM
Form PT-STM
Rev 11 11
Second-Tier Pass-Through Entity Owner Statement
and Waiver Request (for tax years 2011 and earlier)
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
If new address, [X] mark here
Entity Type Code
City
State
Zip Code + 4
1. Will the first-tier pass-through entity file an initial return this year?
Yes
No
2. Will the first-tier pass-through entity file a final return this year?
Yes
No
Second-Tier Pass-Through Entity Information
Name
FEIN
-
Mailing Address
If new address, [X] mark here
Entity Type Code
City
State
Zip Code + 4
1. Will the second-tier pass-through entity file an initial return this year?
Yes
No
2. Will the second-tier pass-through entity file a final return this year?
Yes
No
Waiver Request
Form PT-STM is a waiver request of the requirement of a first-tier pass-through entity to either include a second-tier
pass-through entity in a composite tax return or pay tax on behalf of the second-tier pass-through entity. If a first-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 individual income, corporation license tax, or other income
tax returns, the requirement to file a composite return or pay tax on behalf of the second-tier pass-through entity is waived
on the condition that the first-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 filed or all Montana taxes have not been paid.
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 first-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
Pass-Through Entity Owner Information (following page)
List the owners of the second-tier, third-tier, etc. entities on the following page. To establish that the total distributive share
of Montana source income is accounted for on income or corporation license tax returns, the first-tier pass-through entity
must identify whether or not each owner will file a Montana tax return.
Indicate the number of pages included with the Form PT-STM (including this page).
*11EB0101*
*11EB0101*

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