Form PTE-WX Withholding Exemption Certificate for Individual Owners/Officers/ Directors/Beneficiaries Of Pass-through Entities

08 25 11 1 Resident or part year resident I am an Idaho resident individual or part year resident exempt from withholding since I: 2 Nonresident individual making election under Idaho Code section 63 3022L An individual owner officer director or beneficiary must indicate the reason for claiming an exemption from pass through entity withholding by checking the applicable box below Only one box may be checked EFO00237 Federal employer identification number I am a nonresident and elect to have the pass through entity report and pay the tax on my share of the pass through entity income and compensation paid to me by the pass through entity for this tax year as allowed by Idaho Code section 63 3022L I understand I can't make the election if I have other non pass through entity income I must report to Idaho and I must make this election for all other pass through entities from which I have Idaho income to report I hereby certify I am exempt from withholding by the pass through entity named above of which I am an owner officer director or beneficiary for the reason indicated below: I understand this election is irrevocable and a new election is required for each tax year by the last day of the month following the end of the tax year I understand this exemption must be filed for each year for which I qualify as exempt from withholding Individual Owners/Officers/Directors/Beneficiaries Name of owner/beneficiary Name of pass through entity Of Pass through Entities PTE WX Signature of owner/officer/director/beneficiary Social Security Number This form must be retained by the pass through entity Under penalty of perjury I declare that to the best of my knowledge and belief this form is true correct and complete Was an Idaho part year resident individual with Idaho taxable income from sources other than from another pass through entity Was domiciled (a permanent resident) in Idaho the entire year or maintained a home in Idaho the entire year and spent more than 270 days in Idaho during the tax year Withholding Exemption Certificate For