Form El101 - Maryland E-File Declaration For Electronic Filing - 2009

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FORM

MARYLAND e-File DECLARATION

2009

EL101

FOR ELECTRONIC FILING

1. Keep this form for your records

2. Do not send this form to the State of Maryland unless requested to do so.

3. See Instructions on Page 2.

Taxpayer’s first name and middle initial

Last name

SSN/Taxpayer identification number

Spouse’s first name and middle initial

Last name

SSN/Taxpayer identification number

Present address (number and street)

City or town

State

ZIP code

Part I

Tax Return Information (whole dollars only)

1. Amount of overpayment to be applied to 2010 estimated tax .......................................................................................... ®

REFUND

2. Amount of overpayment to be refunded to you .......................................................................................... ®

3. Total amount due (Pay in full by April 15, 2010. See instructions) .................................................................................... ®

If you file your Maryland Income tax return electronically by 4/15/10, you have until 4/30/10 to make your payment, if you are paying electronically.

Part II

Taxpayer Declaration and Signature Authorization

Check appropriate box to consent to:

Direct Deposit of refund or

Electronic Funds Withdrawal (direct debit)

4a.

Type of account

Checking

Savings

4b.

Routing number

4c.

Account number

Attach

4d.

Direct Debit Settlement Date

(Enter the date you want your payment withdrawn from your account.)

Wage

and

Direct Debit Amount _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

4e.

Tax

Statements

I consent that my refund be directly deposited as designated above, and declare that the information shown is correct. The State of

Here

Maryland is not responsible for a lost refund if I enter the incorrect account information. If I have filed a joint return, this is an irrevocable

appointment of the other spouse as an agent to receive the refund. By consenting, I also agree to disclose to the Maryland State

Treasurer’s Office certain income tax information including name, amount of refund and the above bank information. This disclosure is

necessary to effect direct deposit.

I authorize the State of Maryland and its designated financial agent to initiate an electronic funds withdrawal payment (direct debit) to the

financial institution account indicated for payment of my Maryland and local taxes owed, and the financial institution to debit the entry to

this account. Upon confirmation of consent during the filing of my state return, this authorization is to remain in full force and effect, and I

may not terminate the authorization. I also authorize the financial institutions involved in the processing of this electronic payment of taxes

to receive confidential information necessary to answer inquiries and resolve issues related to the payment.

I do not want direct deposit of my refund or an electronic funds withdrawal (direct debit) of my balance due.

Under penalties of perjury, I declare that I have compared the information contained on my electronic return with the information that I provided to my electronic

return originator or entered on-line and that the name(s), address and amounts described above agree with the amounts shown on the corresponding lines of

my 2009 Maryland electronic income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent that my return,

including accompanying schedules and statements, be sent to the Maryland Revenue Administration Division by my electronic return originator or by my elec-

tronic return software provider.

Please

Sign

Taxpayer’s signature

Date

Spouse’s signature (if joint return, both must sign)

Date

Here

Please wait ten (10) days after the receipt of a valid acknowledgement before calling 410-260-7701 from Central

Maryland, or 1-800-218-8160 from elsewhere, about your refund.

Part III

Declaration of Electronic Return Originator (paid preparer)

I declare that I have reviewed the taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I have

obtained the taxpayer’s signature before submitting the return to the Maryland Revenue Administration Division, have provided the taxpayer with a copy

of all forms and information to be filed with the Maryland Revenue Administration Division, and have followed all other requirements described in the

Handbook for Electronic Filers of Maryland Income Tax Returns. This declaration is to be retained at the site of the electronic return originator.

Date

EFIN

Originator’s

Electronic

signature

Return

Firm’s name (or yours

Originator

if self-employed)

Use Only