Form 510c - Maryland Composite Pass-Through Entity Income Tax Return - 2012 Page 2
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1
2
3FORM
2012
510C
SCHEDULE A
Federal employer identification number (9 digits)
Name
Number and street
City or town
State
ZIP code
MARYLAND COMPOSITE PASS-THROUGH ENTITY INCOME TAX RETURN
PASS THROUGH ENTITY MEMBER INFORMATION FOR COMPOSITE FILERS
A
B
C
D
E
F
G
Standard
PTE
Income
Distributive
Member name
Number of
Exemption
Deduction
Decoupling
allocable
or pro rata
Social Security Number
Exemptions
Amount
Amount
Modifications
to Maryland
share of tax
paid
SUBTOTAL of members from additional
Form 510C Schedule A
TOTALS
COM/RAD 071
12-49
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