EL101C
MARYLAND
FORM
COMBINED CORPORATE REPORTING
20__ __
DECLARATION
CALENDAR YEAR
FOR BUSINESS ELECTRONIC FILING
Or fiscal year beginning
__ __ / __ __ / __ __
ending __ __ / __ __ / __ __
Name of Corporation
Federal employer identification number
Present address (number and street)
City or town
State
ZIP code
Under penalties of perjury, I declare that I am an officer of the above corporation. I have compared the information
contained in my records with the information entered on-line. To the best of my knowledge and belief, the combined
corporate report of the unitary group is true, correct and complete. I consent that the report be submitted through the
Comptroller’s combined corporate reporting Web site to the Comptroller of Maryland by the person named below in
Part II.
Please
Sign
®
®
Here
Corporate officer signature
Title
Date
Part II
Declaration of Electronic Return Originator
I declare that I have reviewed the combined corporate report of the unitary group and that the entries are complete
and correct to teh best of my knowledge. I have obtained the signature of the above identified corporate officer
before submitting the report to the Comptroller of Maryland, and have provided that official with a copy of all
information to be filed with the Comptroller. This declaration will be retained at the site of the filing corporation.
Electronic
Date
EFIN
Report
Originator’s
®
Originator
signature
Use Only
®
Firm’s name (or yours
if self-employed)
ZIP code
Phone
and address
Form EL101C Instructions
Name, Address, Federal Employer Identification Number
must match the information as transmitted. Do not use the originatorʼs address.
Print or type the information in the spaces provided. The name, address and federal employer identification number
Part II – Declaration of Electronic Report Originator
The originator must sign this form. Enter the firm’s name and address. Do not mail this form to the Comptroller of
Maryland or the Revenue Administration Division. This form must be retained at the site of the filing corporation.
For the hearing impaired: Maryland Relay Service 711 (MD)
Annapolis Area TDD: 410-260-7157
COM/RAD-059 09-49
1
