Form El101 – Fill Out and Use This PDF

Attach Wage and Tax Statements Here

Check appropriate box to consent to: Direct Deposit of refund or Electronic Funds Withdrawal (direct debit)

1. Amount to be withdrawn from/deposited in first account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

	Routing number (9-digit)  _ _ _ _ _ _ _ _ _	c 	Checking	Savings
	Account number  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
	Direct Debit Settlement Date ____/____/____ (Enter the date you want your payment withdrawn from your account.)
						2
2.	Amount to be deposited in second account	. . . .	. . . . . . . . . . . . . . . . . . . . .	. . . . .	
	Routing number (9-digit)  _ _ _ _ _ _ _ _ _	c 	Checking	Savings
	Account number  _ _ _ _ _ _ _ _ _ _ _ _ _
						3
3.	Amount to be deposited in third account	. . . .	. . . . . . . . . . . . . . . . . . . . .	. . . . .	
	Routing number (9-digit)  _ _ _ _	c 	Checking	Savings
	Account number  _ _ _ _ _		_ _ _ _ _

4a. I consent that my refund be directly deposited as designated above and declare that the information shown is correct. The State of Maryland is not responsible for a lost refund if I enter the incorrect account information. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund. By consenting, I also agree to disclose to the Maryland State Treasurer's Office certain income tax information including name, amount of refund and bank information. This disclosure is necessary to effect direct deposit.

4b. I authorize the State of Maryland and its designated financial agent to initiate an electronic funds withdrawal payment (direct debit) to the financial institution account indicated on above for payment of my Maryland and local taxes owed, and the financial institution to debit the entry to this account. Upon confirmation of consent during the filing of my 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.

4c.		I do not want direct deposit of my refund or an electronic funds withdrawal (direct debit) of my balance due.

Electronic

Return

Originator

Use Only

Originator’s  signature

Firm’s name (or yours

if self-employed) and address

Date	EFIN

ZIP code	Phone

Form EL101 Instructions 2011

Purpose of Form EL101

Form EL101 is the signature document for an e-Filed return filed by an online electronic transmitter or electronic return originator (ERO). It also serves as a declaration document regarding consent for: direct deposit of refund, electronic funds withdrawal (direct debit) for a liability and for a return to be electronically filed. This form should be completed for all Maryland e-Filed returns and retained by the taxpayer and ERO for 3 years from the return due date or Maryland received date, whichever is later. Do not send this form to the State of Maryland unless specifically requested to do so.

ERO Responsibilities

The ERO must:

1.Enter the name(s) and Social Security number(s) of the taxpayer(s) at the top of the form. Do not use the ERO’s address.

2.Complete Part I using the amounts (zeros may be entered when appropriate) from the taxpayer’s 2011 tax return.

3.If the taxpayer(s) elected to have direct deposit of their refund, or electronic funds withdrawal (direct debit) for all or part of their liability, check the appropriate box in Part II. The taxpayer(s) should check with their financial institution to make sure their deposit or debit will be accepted and to get the correct routing and account numbers. For direct debit only account (1) should be used.

4.After completing the form through Part II, give the taxpayer(s) Form EL101 for review and signature(s). This can be done in person, by mail or by secure e-mail.

5.The originator (paid preparer) must sign Form EL101 and include their electronic filer identification number (EFIN) and firm name and address. An electronically transmitted income tax return will be considered incomplete unless and until a correctly completed Form EL101 is signed by the taxpayer(s) and/or by the ERO if applicable. If a joint return is filed, both taxpayers must sign. The taxpayer(s) must sign the completed EL101 before the electronic record is transmitted.

6.If the ERO makes changes to the electronic return after FORM EL101 has been signed by the taxpayer(s), but before the return is transmitted, the originator must have the taxpayer(s) sign a corrected Form EL101. See the 2011 Maryland Personal EMS and MeF e-File Handbook(s).

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7.Provide a completed copy of Form EL101 to the taxpayer(s) for their records.

8.A copy of Form EL101 with applicable attachments must be retained for 3 years at the site of the ERO. The ERO must make a copy of Form EL101 available to the State of Maryland if specifically requested to do so by the Revenue Administration Division.

Taxpayer Responsibilities

Taxpayer(s) must:

1.Verify the accuracy of the prepared income tax return, including direct deposit and direct debit information if applicable.

2.Sign and date Form EL101 authorizing electronic transmission of the state income tax return, even if the return is filed from a personal computer and the federal PIN is used as electronic signature on the state return.

3.Retain a copy of the Form EL101 along with a copy of the state income tax return for a period of 3 years from the return due date or Maryland received date, whichever is later.

4.Make a copy of the Form EL101 available to the State of Maryland if formally requested to do so by the Revenue Administration Division.

The Form EL101 should not be mailed to Maryland Revenue Administration Division unless specifically requested to do so.

Certification Requirements for Electronically filed Tax Returns

Some credits allowed on an electronic return require supporting documentation to be e-mailed or mailed to the State once the electronic return has been accepted. When sending required supporting documentation and certifications, please send Form EL101 as a cover sheet and write the name of the credit for which certification is being submitted on the face of the form, directly under the tax year.

The preparer or taxpayer will have fourteen (14) calendar days to forward this form with the requested certification(s), either by e-mail to cert@comp.state.md.us or by mail to: Revenue Administration Division, Electronic Processing Section, P.O. Box 2364, Annapolis, MD 21404

This post office box should be used only for certifications and supporting documents required for the 2011 e-File return. For a complete list of certification requirements, refer to the 2011 Maryland Personal EMS and MeF e-File Handbook(s).