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Maryland Form 11t - Public Service Company Franchise Tax Return, Telephone Companies - 2009 Page 2

14. Does the taxpayer conduct business in more than one state?

_________Yes

_________No

15. Identify the amount of Taxable Maryland Gross Receipts (Line 9) that are attributable to interstate revenues $ _________________

_________________________________________________________________________________________________________________

I declare under the penalties of perjury that this return, including any accompanying schedules and statements, has been

examined by me and to the best of my knowledge and belief is a true, correct, and complete return.

_____________

_______________________________

________________

___________________________

Officer’s Signature

Date

Preparer’s Signature

Date

________________________________________________

_________________________________________________________

________________________________________________

Title

Firm name, address and phone number

_________________________________________________________________________________________________________________

Make Checks Payable to Department of Assessments and Taxation

Tax Payments of $10,000 or more must be remitted by Electronic Funds Transfer

□

If payment is made through EFT, check this box

Please use the bank account number as indicated in the ACH credit tax payment instructions

Mail this form with payment to:

Department of Assessments and Taxation

Franchise Tax Unit

301 West Preston Street

Baltimore, Maryland 21201-2395

: (410) 767-1940

OR ASSISTANCE

CALL

_________________________________________________________________________________________________________________

FOR DEPARTMENT USE ONLY

REPORT RECEIVED

POSTED

AUDITED

TAX DEFICIENCY

INTEREST/PENALTY

Maryland Form 11t - Public Service Company Franchise Tax Return, Telephone Companies - 2009 Page 2