MONTANA
Clear Form
QEC
Rev 05 11
2011 Qualified Endowment Credit
15-30-2327 and 15-30-2328, 15-31-161 and 15-31-162, MCA
Name (as it appears on your Montana tax return)
Social Security
Federal Employer
-
-
-
X X X - X X - X X X X
X X - X X X X X X X
OR
Number
Identification Number
Partners in a Partnership or Shareholders of an S Corporation
Enter your share of the qualified endowment credit here. See instructions.
$_____________________
Business Name of Partnership or Corporation
Federal Employer
-
Identification Number
___________________________________________________
1a. List the name and address of the tax-exempt Montana organization, qualified under 26 U.S.C. 501(c)(3), that is
holding the qualified endowment.
Name
_______________________________________________________________________________
Address
_______________________________________________________________________________
City, State, Zip _______________________________________________________________________________
b. List the name and address of the trustee of the trust administering the planned gift.
Name
_______________________________________________________________________________
Address
_______________________________________________________________________________
City, State, Zip _______________________________________________________________________________
c. List the name and address of the bank or trust company holding the qualified endowment on behalf of a tax-exempt
organization.
Name
_______________________________________________________________________________
Address
_______________________________________________________________________________
City, State, Zip _______________________________________________________________________________
2. Mark the appropriate box indicating the type of gift you contributed.
q Charitable remainder unitrust
q Charitable gift annuity
q Charitable remainder annuity trust
q Deferred charitable gift annuity
q Pooled income fund trust
q Charitable life estate agreement
q Charitable lead unitrust
q Paid-up life insurance policy
q Charitable lead annuity trust
q Qualified outright charitable contribution. An outright charitable contribution qualifies for this credit only when a
C corporation, S corporation, partnership, trust, estate, or limited liability company makes the contribution. An
individual cannot claim this credit for an outright charitable contribution.
3. Date the qualified contribution was made......................................................................................3.
4. The present value of the aggregate amount of the charitable gift portion of your planned gift, or
your outright charitable contribution (the charitable deduction amount). .......................................4.
5. If your gift is a planned gift, multiply line 4 by 40% (0.40) and enter the result here, but not more
than $10,000. If your gift is a qualified outright charitable contribution, multiply line 4 by 20%
(0.20) and enter the result here, but not more than $10,000. This is your qualified endowment
credit. ............................................................................................................................................5.
Where to Report Your Credit
►Individuals: Form 2, Schedule V
►S corporations: Form CLT-4S, Schedule II
►C corporations: Form CLT-4, Schedule C
►Partnerships: Form PR-1, Schedule II
►Estate or Trusts: Form FID-3, Line 32
If you file your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you file electronically, you
represent that you have retained the required documents in your tax records and will provide them upon the department’s request.
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