Form D-20 - Columbia Corporation Franchise Tax Return - 2015 Page 7

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*152300110002*

Worldwide Combined Reporting

Government of the

District of Columbia

Election Form

Fill in

if FEIN

Worldwide

FEIN/SSN of Designated Agent

Taxable Year YYYY

Fill in

if SSN

Telephone number

Name of Designated Agent

Business address line #1

Business address line #2

City

State

Zip code +4

•

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It may be withdrawn or reinstituted after withdrawal, prior to the expiration of the ten-year period, only upon written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

Date Beginning Tax Period: MMDDYYYY

Date Ending Tax Period: MMDDYYYY

Authorized Signature

Printed Name

Date

Under penalties of law, I declare that the designated agent has authorized me to sign on behalf of all members of the combined 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.

2015 Worldwide Combined Reporting Election Form