Income
Income Tax
Pass through entity (PTE) name
(one owner per line)
(Required with Forms 41S 65 or 66)
07 24 14
By Entity
City State ZIP Code
Composite
Contact email
Contact name
Contact telephone
Date of payment
Distributable
Distributable
EFO00241
EIN or
Entity
Filing
Idaho
Idaho
Idaho Schedule For Pass Through Owners
If you have more than one schedule enter the total amounts on last page only
Income
Income
Number
Other
Owner s Address
Owner s Name
Page of
PTE 12
PTE EIN
PTE tax year ending
Social Security
Tax Paid
Total Columns (b) (c) (d) (e) and (f)
Withheld By
Withholding
