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This document is a Montana W-2 Withholding Declaration form. It requests information from the taxpayer and employer such as names, addresses, social security number, FEIN, total wages paid, and federal and state income taxes withheld. The taxpayer declares under penalty of perjury that the employer did not or refused to provide a W-2, and that the Montana tax withheld amount was calculated from attached documents. The taxpayer signs and dates the form.