CALENDAR YEAR
MARYLAND COMBINED CORPORATE
FORM
20__ __
EL101C
REPORTING DECLARATION FOR BUSINESS
Or fiscal year beginning
ELECTRONIC FILING
__ __ / __ __ / __ __
__ __ / __ __ / __ __
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
Corporate officer signature
Title
Date
Here
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 the 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.
Date
EFIN
Originator’s
Electronic
signature
Return
Originator
Firm’s name (or yours
Use Only
if self-employed)
ZIP code
Phone
and address
Form EL101C Instructions
Name, Address, Federal Employer Identification Number
Print or type the information in the spaces provided. The name, address and federal employer identification number must match
the information as transmitted. Do not use the originator’s address.
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
COM/RAD-059 10-49
10-49
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