Form At3-28 - Annual Report And Personal Property Return Of Financial Institutions - 2017

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17
STATE OF MARYLAND
ANNUAL REPORT AND
20____
PERSONAL PROPERTY RETURN OF
DEPARTMENT OF ASSESSEMENTS & TAXATION
FORM
FINANCIAL INSTITUTIONS
Personal Property Division
AT3-28
301 West Preston St., Room 801
st
AS OF JANUARY 1
Baltimore, Maryland 21201-2395
th
DUE APRIL 15
Date Received
sdat.persprop@Maryland.gov
$300 Filing Fee Required
(410) 767-1170
Toll Free in Maryland 1-888-246-5941
Maryland Department ID Number
Name of Financial Institution
____ ____ ____ ____ ____ ____ ____ ____
Check here
Federal Employer ID Number
Mailing Address
if this is
a change
____ ____ ____ ____ ____ ____ ____ ____ ____
of address
Federal Principal Business Code
City
State
Zip Code
______ ______ ______ ______ ______ ______
SECTION I
A. Date of incorporation/formation ___________________ State of incorporation/formation _________________________
B. Nature of business conducted in Maryland (Credit, finance, Loan, etc.) ________________________________________
C. Does the financial institution do any part of its business in the state of Maryland? __________ Date began ____________
(Yes or No)
D. Does the financial institution own personal property NOT used directly for the purposes for which the institution was
formed or which is leased, loaned or otherwise made available for the use of any person whose business is not that of the
institution?
YES ______ NO ______
E. Is this personal property in Maryland? YES ______ NO ______
i. If the answer to either D or E above is NO, please complete the rest of this page" sign this return on page 2
and submit with $300 filing fee made payable to the Department of Assessments and Taxation and note your
Maryland Department ID Number on the check.
ii. If the answer to D and E above is YES, please complete the rest of this return.
F. Type or print names and addresses of officers and names of directors (corporations only):
OFFICERS
Names
Addresses
President
___________________________________
________________________________________________
Vice President
___________________________________
________________________________________________
Secretary
___________________________________
________________________________________________
Treasurer
___________________________________
________________________________________________
DIRECTORS
Names
Names
___________________________________
________________________________________________
___________________________________
________________________________________________
___________________________________
________________________________________________
___________________________________
________________________________________________
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