Form El101b Draft - Maryland Income Tax Declaration For Business Electronic Filing - 2011

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2011
MARYLAND INCOME TAX DECLARATION
FORM
EL101B
FOR BUSINESS ELECTRONIC FILING
See instructions on page 2
For fiscal year beginning
2011, ending
Name of corporation or pass-through entity
Federal employer 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 2012 estimated tax (Corporations only) . . . . . .
REFUND
2.
Amount of overpayment to be refunded (Corporations only) . . . . . . . . . . . . . . .
3.
Total amount due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II
Declaration
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
4d. Direct debit settlement date _____ / _____ / _____
(Enter the date you want the payment withdrawn from the account.)
Draft 9/16/2011
4e. Direct debit amount _____________________
I consent that the corporation’s refund be directly deposited as designated above, and declare that the information shown is correct. 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 entry to the financial institution
account indicated for payment of the Maryland taxes owed by the corporation or pass-through entity and the financial institution to debit the entry
to this account. Upon confirmation of consent during the filing the corporation or pass-through entity 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 the refund or an electronic funds withdrawal (direct debit) of the balance due.
Under penalties of perjury, I declare that I am an officer, general partner or managing member of the above corporation or of the pass-through entity. 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 2011 Maryland electronic income tax
return. To the best of my knowledge and belief, the return is true, correct and complete. I consent that the return, including accompanying schedules and
statements, be sent to the Maryland Revenue Administration Division by my electronic return originator or by the electronic return software provider.
Please
Sign
Here
Corporate officer, general partner or managing member’s signature
Title
Date
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 the refund.
Part III
Declaration of Electronic Return Originator (paid preparer)
I declare that I have reviewed the return of the corporation or pass-through entity and that the entries on this form are complete and correct to the best of my
knowledge. I have obtained the signature of the corporate officer, general partner or managing member, before submitting the return to the Maryland Revenue
Administration Division, have provided that official 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 Maryland Business E-File Handbook. 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)
ZIP code
Phone
Use Only
and address
COM/RAD-060
11-49

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