Form Rw-3 Montana Annual Mineral Royalty Withholding Tax Reconciliation 2013 Page 2
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1
2MONTANA
CLEAR FORM
RW-3
Rev 03 13
2013
Montana Annual Mineral Royalty Withholding Tax Reconciliation
-
_______________________________
FEIN
Name
M R
W
______________________________
Account ID
Address
________________________________
_____________________________
City
Pay Frequency
Address
_____
___________
Due Date
State
Zip
0 2 2 8 2 0 1 4
Change
If this is an amended return, mark this box.
If your business has ceased and you would like your account closed, mark this box and indicate cease date. ___/ ___ / ______
1. Number of Forms 1099-MISC/1042-S with Montana withholding
Paper
Electronic
2. Number of Forms 1099-MISC/1042-S without Montana withholding
Paper
Electronic
3. Total Montana net royalty payments
.
4. Total Montana tax withheld, per Forms 1099-MISC/1042-S
.
5. Total Montana mineral royalty withholding tax paid
.
6. Difference (line 4 minus line 5)
.
May we discuss this return with your tax preparer?
Yes
No
If yes, provide preparer name and telephone number below:
________________________________________________
Please complete columns below as described in the instructions.
B
A
C
D
E
Quarterly
Montana Net Royalty
Date(s) Paid to MT DOR
Montana Tax Withheld
Montana Tax Paid
Difference
Report
No slashes or dashes
Payments
Period
in dates please.
2013
M M D D Y Y Y Y
Jan-Mar
M M D D Y Y Y Y
Apr-Jun
Jul-Sep
M M D D Y Y Y Y
Oct-Dec
M M D D Y Y Y Y
*13EM0101*
*13EM0101*
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