2011 Instructions To Complete The Dc Combined Report (Page 20 of 37) in pdf

2011 Instructions To Complete The Dc Combined Report Page 20

Form to Make an Election to File a

Government of the

District of Columbia

Worldwide DC Combined Franchise Tax Return

Taxpayer Identification Number

Taxable year ending: MMYY

Name of Designated Agent

Telephone number

DC business address line #1

DC business address line #2

City

State

Zip code +4

Worldwide

• In accordance with the provisions of DC Official Code § 47-1810.07 and the combined reporting regulations, election is

hereby made to report on a worldwide unitary combined basis.

• A worldwide unitary combined reporting election is binding for and applicable to the tax year it is made and all years

thereafter for a period of ten years.

• It may be withdrawn or reinstituted after withdrawal, prior to the expiration of the ten-year period, only upon written

request for reasonable cause based on extraordinary hardship due to unforeseen changes in state tax statutes, law or

policy and only with the written permission from the Office of Tax and Revenue.

• Upon the expiration of the ten-year period, a taxpayer may withdraw from the worldwide unitary combined reporting

election.

• Withdrawal must be made in writing within one year of the expiration of the election and is binding for a period of ten

years, subject to the same conditions as applied to the original election.

Company Name

FEIN

Date Beginning Tax Period: MMDDYYYY

Date Ending Tax Period: MMDDYYYY

Authorized Signature

Printed Name

Date

Under penalties of Perjury, I declare that the designated agent has authorized me to sign on behalf of all members of the combine group, and

that I have examined this form and the information contained herein is, to the best of my knowledge and belief, correct and complete

2011 Instructions To Complete The Dc Combined Report Page 20