Maryland Form 11t - Public Service Company Franchise Tax Return, Telephone Companies - 2011 Page 2

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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
F
,
: (410) 767-1940
OR ASSISTANCE
CALL
_________________________________________________________________________________________________________________
FOR DEPARTMENT USE ONLY
REPORT RECEIVED
POSTED
AUDITED
TAX DEFICIENCY
INTEREST/PENALTY

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