Fillable Form 2021: *210300110002* 0002 (Government of the District of Columbia)

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Form 2021: *210300110002* 0002 (Government of the District of Columbia)

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2021
07/2021
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IF
LINE 11 IS $12,000 OR LESS, YOU ARE NOT REQUIRED TO FILE THIS RETURN
unless you may need Clean Hands Certification.
0002
*210300110002*
Print
Clear
D-30 FORM, PAGE 2
2
2
3
2
32
33 33
34
3 33
3
3 income. 3 3
3 3
3
3
42
43
44
4
3
4 3
4
4
ENTER DOLLAR AMOUNTS ONLY
TAXABLE INCOME
TAX, PAYMENTS AND CREDITS
2 $
.00
2 $
.00
2 $
.00
2
2 $
.00
$
.00
3 $
.00
33 $
.00
34
.
3
.
3
$
.00
2 $
.00
$
.00
.
3
.
3
.
.
3
.
.
4 $
.00
43 $
.00
4 $
.00
.
$ .00
$ .00
$ .00
4 $
.00
$
.00
$ .00
25 $ .00
22 $ .00
23
24 3
2
2
24
.
23 .
07/2021
2021
If this is an amended 2021
2022
*210300120002*
Schedule A - COST OF GOODS SOLD
1.
2.
3.
. 4
. 5
6.
7.
8. Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2.
Method of inventory valuation used
__________________________________________________________________
Schedule B - CONTRIBUTIONS AND/OR GIFTS
Schedule C - TAXES 1
TOTAL
Schedule E - INTEREST EXPENSE
D-30 FORM, PAGE 3
*210300110000*
07/2021
Schedule A - COST OF GOODS SOLD
1.
2.
3.
. 4
. 5
6.
7.
8. Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2.
Method of inventory valuation used
__________________________________________________________________
Schedule B - CONTRIBUTIONS AND/OR GIFTS
Schedule C - TAXES 1
TOTAL
Schedule E - INTEREST EXPENSE
D-30 FORM, PAGE 3
*210300110000*
07/2021
Schedule A - COST OF GOODS SOLD
1.
2.
3.
. 4
. 5
6.
7.
8. Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2.
Method of inventory valuation used
__________________________________________________________________
Schedule B - CONTRIBUTIONS AND/OR GIFTS
Schedule C - TAXES 1
TOTAL
Schedule E - INTEREST EXPENSE
D-30 FORM, PAGE 3
*210300110000*
07/2021
D-30 FORM, PAGE 2
2
2
3
2
32
33 33
34
3 33
3
3 income. 3 3
3 3
3
3
42
43
44
4
3
4 3
4
4
ENTER DOLLAR AMOUNTS ONLY
TAXABLE INCOME
TAX, PAYMENTS AND CREDITS
2 $
.00
2 $
.00
2
$
.00
2
2 $
.00
$
.00
3 $
.00
33 $
.00
34
.
3
.
3
$
.00
2 $
.00
$
.00
.
3
.
3
.
.
3
.
.
4 $
.00
43 $
.00
4 $
.00
.
$ .00
$ .00
$ .00
4 $
.00
$
.00
$ .00
25 $ .00
22 $ .00
23
24 3
2
2
24
.
23 .
*210300120000*
07/2021
2021
If this is an amended 2021
2022
Schedule A - COST OF GOODS SOLD
1.
2.
3.
. 4
. 5
6.
7.
8. Cost of goods sold (Line 6 minus Line 7). Enter here and on D-30, Line 2.
Method of inventory valuation used
__________________________________________________________________
Schedule B - CONTRIBUTIONS AND/OR GIFTS
Schedule C - TAXES 1
TOTAL
Schedule E - INTEREST EXPENSE
D-30 FORM, PAGE 3
07/2021
*210300130002*
D-30 FORM, PAGE 2
2
2
3
2
32
33 33
34
3 33
3
3 income. 3
3
3 3
3
3
42
43
44
4
3
4 3
4
4
ENTER DOLLAR AMOUNTS ONLY
TAXABLE INCOME
TAX, PAYMENTS AND CREDITS
2
$
.00
2
$
.00
2 $
.00
2
2 $
$
3 $
33 $
34
3
3
$
.00
2
$
.00
$
.
3
3
.
3
.
4 $
.00
43 $
.00
4 $
.00
.
$ .00
$ .00
$ .00
4 $
.00
$
.00
$ .00
25 $ .00
22 $ .00
23
24 3
2
2
24
.
23 .
*210300110000*
07/2021
2021
If this is an amended 2021
2022
D-30 FORM, PAGE 2
2
2
3
2
32
33 33
34
3 33
3
3 income. 3
3
3 3
3
3
42
43
44
4
3
4 3
4
4
ENTER DOLLAR AMOUNTS ONLY
TAXABLE INCOME
TAX, PAYMENTS AND CREDITS
2
$
.00
2
$
.00
2 $
.00
2
2 $
$
3 $
33 $
34
3
3
$
.00
2
$
.00
$
.
3
3
.
3
.
4 $
.00
43 $
.00
4 $
.00
.
$ .00
$ .00
$ .00
4 $
.00
$
.00
$ .00
25 $ .00
22 $ .00
23
24 3
2
2
24
.
23 .
*210300110000*
07/2021
2021
If this is an amended 2021
2022
D-30 FORM, PAGE 2
2
2
3
2
32
33 33
34
3 33
3
3 income. 3
3
3 3
3
3
42
43
44
4
3
4 3
4
4
ENTER DOLLAR AMOUNTS ONLY
TAXABLE INCOME
TAX, PAYMENTS AND CREDITS
2 $
.00
2
$
.00
2 $
.00
2
2 $
$
3 $
33 $
34
3
3
$
.00
2 $
.00
$
.
3
3
.
3
.
4 $
.00
43 $
.00
4 $
.00
.
$ .00
$ .00
$ .00
4 $
.00
$
.00
$ .00
25 $ .00
22 $ .00
23
24
3
2
2
24
.
23 .
*210300110000*
07/2021
2021
If this is an amended 2021
2022
Schedule F - DC apportionment factor (See instructions) Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.
Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.
Column 1 TOTAL Column 2 in DC DC Apportionment
Factor
.
.00
.00
Schedule G - Other allowable deductions
TOTAL 2
Schedule H - Income not reported
SALES FACTOR:
DC APPORTIONMENT FACTOR:
D-30 FORM, PAGE 4
Schedule - Disregarded Entities
PLEASE
SIGN
HERE
PAID
PREPARER
ONLY
and enter the name and phone number of that person. See instructions.To authorize another person to discuss this return with OTR, fill in here
07/2021
*210300140002*
D-30 FORM, PAGE 5
Schedule I - BALANCE SHEETS
LIABILITIES AND CAPITAL
ASSETS
2
Schedule J - DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)
Col. 4 - See Instructions.
Col. 5 - See Instructions.
Col. 6 - Any loss amount from Line 31 of D-30.
Col. 7 - Enter the difference between Line 25 and Line 31 of D-30.
07/2021
*210300110000*
D-30 FORM, PAGE 5
Schedule I - BALANCE SHEETS
LIABILITIES AND CAPITAL
ASSETS
2
Schedule J - DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)
Col. 4 - See Instructions.
Col. 5 - See Instructions.
Col. 6 - Any loss amount from Line 31 of D-30.
Col. 7 - Enter the difference between Line 25 and Line 31 of D-30.
07/2021
*210300110000*
D-30 FORM, PAGE 5
Schedule I - BALANCE SHEETS
LIABILITIES AND CAPITAL
ASSETS
2
Schedule J - DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)
Col. 4 - See Instructions.
Col. 5 - See Instructions.
Col. 6 - Any loss amount from Line 31 of D-30.
Col. 7 - Enter the difference between Line 25 and Line 31 of D-30.
07/2021
*210300110000*
D-30 FORM, PAGE 5
Schedule I - BALANCE SHEETS
LIABILITIES AND CAPITAL
ASSETS
2
Schedule J - DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)
Col. 4 - See Instructions.
Col. 5 - See Instructions.
Col. 6 - Any loss amount from Line 31 of D-30.
Col. 7 - Enter the difference between Line 25 and Line 31 of D-30.
07/2021
*210300110000*
Schedule F - DC apportionment factor (See instructions) Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.
Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.
Column 1 TOTAL Column 2 in DC DC Apportionment
Factor
.
.00
.00
Schedule G - Other allowable deductions
TOTAL 2
Schedule H - Income not reported
SALES FACTOR:
DC APPORTIONMENT FACTOR:
D-30 FORM, PAGE 4
Schedule - Disregarded Entities
PLEASE
SIGN
HERE
PAID
PREPARER
ONLY
and enter the name and phone number of that person. See instructions.To authorize another person to discuss this return with OTR, fill in here
07/2021
*210300140000*
D-30 FORM, PAGE 5
Schedule I - BALANCE SHEETS
LIABILITIES AND CAPITAL
ASSETS
2
Schedule J - DISTRIBUTION AND RECONCILIATION OF NET INCOME (OR LOSS)
Col. 4 - See Instructions.
Col. 5 - See Instructions.
Col. 6 - Any loss amount from Line 31 of D-30.
Col. 7 - Enter the difference between Line 25 and Line 31 of D-30.
07/2021
*210300150002*
Schedule F - DC apportionment factor (See instructions) Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.
Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.
Column 1 TOTAL Column 2 in DC DC Apportionment
Factor
.
.00
.00
Schedule G - Other allowable deductions
TOTAL 2
Schedule H - Income not reported
SALES FACTOR:
DC APPORTIONMENT FACTOR:
D-30 FORM, PAGE 4
Schedule - Disregarded Entities
PLEASE
SIGN
HERE
PAID
PREPARER
ONLY
and enter the name and phone number of that person. See instructions.To authorize another person to discuss this return with OTR, fill in here
07/2021
*210300110000*
Schedule F - DC apportionment factor (See instructions) Note: If this is a combined report do not use Schedule F to derive the apportionment factor for the group.
Leave Schedule F blank. Use Combined Reporting Schedule 2A, Line 9 instead.
Column 1 TOTAL Column 2 in DC DC Apportionment
Factor
.
.00
.00
Schedule G - Other allowable deductions
TOTAL 2
Schedule H - Income not reported
SALES FACTOR:
DC APPORTIONMENT FACTOR:
D-30 FORM, PAGE 4
Schedule - Disregarded Entities
PLEASE
SIGN
HERE
PAID
PREPARER
ONLY
and enter the name and phone number of that person. See instructions.To authorize another person to discuss this return with OTR, fill in here
07/2021
*210300110000*
*212300210000*
Government of the
District of Columbia
Business Credits
Revised 08/2021
Important: Print in CAPITAL letters using black ink.
Attach to your Form D-20 or D-30.
Fill in if filing a D-20 Return
Fill in if filing a D-30 Return
Taxpayer IdentiĐcation Number
Fill in if FEIN
Fill in if SSN
Enter your business name
D-20 Return
Nonrefundable Credits (Nonrefundable Credits may not be applied against the required minimum tax)
1 1 $ .00
Economic Development Zone Incentives Credits (see worksheet).
2 QualiĐed High Technology Company Credits
from Part D, Line 4a, DC Form D-20CR. 2 $ .00
3 Organ and Bone Marrow Donor Credit (see computation on reverse side). 3 $ .00
4 Job Growth Incentive Act 4 $ .00
5 Enter alternative fuel credits. See instructions
5a Alternative fuel infrastructure.
5b Alternative fuel vehicle conversion.
6 Total alternative fuel credits. Add Lines 5a and 5b only and enter here. 6
$ .00
7 Employer-assisted Home Purchase Tax Credit (see computation on reverse side). 7a 7 $ .00
# of employees
8
RESERVED
8 $ .00
9
Total the nonrefundable D-20 credits, enter here and on Form D-20, Line 38. 9 $ .00
Refundable Credits
10
10 $ .00
11 $ .00
11
12 Total the refundable D-20 credits, enter here and on Form D-20, Line 41
d .
12
$ .00
D-30 Return
Nonrefundable Credits (Nonrefundable Credits may not be applied against the required minimum tax)
13 Economic Development Zone Incentives Credit (see worksheet).
13 $
.00
14 $
.00
15 $ .00
14
(see computation on reverse side)
15
16
Organ and Bone Marrow Donor Credit
Job Growth Incentive Act
lternative See instructions
16a Alternative fuel infrastructure.
16b Alternative fuel vehicle conversion.
17 Total alternative fuel credits. Add Lines 16a and 16b only and enter here. 17 $ .00
18 Employer-assisted Home Purchase Tax Credit (see computation on reverse side). 18a 18 $ .00
# of employees
19
19
$ .00
20 Total the nonrefundable D-30 credits, enter here and on Form D-30, Line 38.
20
$ .00
Schedule UB Instructions - Qualified High Technology Companies
If you claim credits on Lines 2 above, attach a copy of your DC Form D-20CR to the D-20.
OFFICIAL USE ONLY
Vendor ID# 0000
$ .00
# of stations
$
.00
# of stations
$ .00
# of vehicles
$ .00
# of vehicles
Refundable Credits
1 $
.00
1
2 otal the refundable D- 0 credits, enter here and on Form D- 0, Line 41(d).
2 $
.00
2021
SCHEDULE UB
DC Low-Income Housing Tax Credit (see instructions).
DC Low-Income Housing Tax Credit (see instructions).
D-30 FORM, PAGE 6
SUPPLEMENTAL INFORMATION
2021,
2021?
2021?
2020?
07/2021
*212300210002*
Government of the
District of Columbia
Business Credits
Revised 08/2021
Important: Print in CAPITAL letters using black ink.
Attach to your Form D-20 or D-30.
Fill in if filing a D-20 Return
Fill in if filing a D-30 Return
Taxpayer
Identification Number
Fill in if FEIN
Fill in if SSN
Enter your business name
D-20 Return
Nonrefundable Credits (Nonrefundable Credits may not be applied against the required minimum tax)
1 1 $ .00
Economic Development Zone Incentives Credits (see worksheet).
2
Qualified High Technology Company Credits from Part D, Line 4a, DC Form D-20CR.
2 $ .00
3 Organ and Bone Marrow Donor Credit (see computation on reverse side). 3 $ .00
4 Job Growth Incentive Act 4 $ .00
5 Enter alternative fuel credits. See instructions
5a Alternative fuel infrastructure.
5b Alternative fuel vehicle conversion.
6 Total alternative fuel credits. Add Lines 5a and 5b only and enter here. 6
$ .00
7 Employer-assisted Home Purchase Tax Credit (see computation on reverse side). 7a 7 $ .00
# of employees
8
RESERVED
8 $ .00
9
Total the nonrefundable D-20 credits, enter here and on Form D-20, Line 38. 9 $ .00
Refundable Credits
10
10 $ .00
11 $ .00
11
12 Total the refundable D-20 credits, enter here and on Form D-20, Line 41
d .
12
$ .00
D-30 Return
Nonrefundable Credits (Nonrefundable Credits may not be applied against the required minimum tax)
13 Economic Development Zone Incentives Credit (see worksheet).
13 $
.00
14 $
.00
15 $ .00
14
(see computation on reverse side)
15
16
Organ and Bone Marrow Donor Credit
Job Growth Incentive Act
lternative See instructions
16a Alternative fuel infrastructure.
16b Alternative fuel vehicle conversion.
17 Total alternative fuel credits. Add Lines 16a and 16b only and enter here. 17
$ .00
18 Employer-assisted Home Purchase Tax Credit (see computation on reverse side). 18a 18 $ .00
# of employees
19
19
$ .00
20 Total the nonrefundable D-30 credits, enter here and on Form D-30, Line 38.
20
$ .00
Schedule UB Instructions - Qualified High Technology Companies
If you claim credits on Lines 2 above, attach a copy of your DC Form D-20CR to the D-20.
OFFICIAL USE ONLY
Vendor ID# 0002
$ .00
# of stations
$
.00
# of stations
$ .00
# of vehicles
$ .00
# of vehicles
Refundable Credits
1 $
.00
1
2 otal the refundable D- 0 credits, enter here and on Form D- 0, Line 41(d).
2 $
.00
2021
SCHEDULE UB
DC Low-Income Housing Tax Credit (see instructions).
DC Low-Income Housing Tax Credit (see instructions).
Clear
Print
Government of the
District of Columbia
2019
SCHEDULE SR Small Retailer
Property Tax Relief Credit
Important: Read eligibility requirements before completing.
Print in CAPITAL letters using black ink.
Revised 09/2019
l
l
l
Telephone number
Owner/Landlord’s address (number and street)
City State Zip Code +4
7 If Owner, enter information from your real property tax bill or assessment. If a section is blank on your property tax bill, leave it blank here.
Square number Suffix number Lot number
Address of Class 2 DC Property (number, street and suite number if applicable) for which you are claiming the credit if different from above
◆ Do not claim this credit if your qualified business is exempt from or receives any tax credits towards its real property
tax or the qualified rental retail location or the qualified owned retail location is otherwise exempt from real property
tax.
◆ The credit equals the total Class 2 real property taxes paid by a qualified corporation or qualified unincorporated
business for a qualified retail owned location during the taxable year not to exceed $5,000; or 10% of the total rent
paid by a qualified corporation or qualified unincorporated business for a qualified rental retail location not to exceed
$5,000.
OFFICIAL USE ONLY Vendor ID#0000
6 Owner/Landlord’s name
2 $
.00
4 $
.00
5
$
.00
Fill in
Fill in
if filing a D-20 Return
if filing a D-30 Return
Taxpayer Identification Number
Fill inill in
Fill inill in
Enter your business name
3 Enter the Class 2 property taxes paid in 2019 on qualified owned retail location
or 10% of rent paid in taxable year 2019 on qualified rental retail location.
4 Property Tax Credit Limit.
0
0
0
5
1 Amount of federal gross receipts or sales. Do not make claim if $2.5m or more.
1 $ .00
2 If tenant, amount of rent paid in taxable year 2019 on qualified retail location.
3
$
.00
5 Small Retailer Property Tax Relief Credit. Enter the smaller of Line 3 or Line 4 here,
and on Schedule UB, Line 11 if incorporated, or Line 21 if unincorporated.
Mailing address (number, street and suite number if applicable)
City State Zip Code +4
*19SR00110000*
if FEIN
if SSN
Sales and Use Tax Account Number
Certificate of Occupancy Permit Number
If member of a Combined Group, Taxpayer Identification Number of Designated Agent
City
State Zip Code +4
Organ and Bone Marrow Donor Credit
An employer who provides an employee with paid leave to donate an organ (up to
30 days leave) or to donate bone marrow (up to 7 days leave) is eligible to claim a
credit against the franchise tax. The credit is equal to 25% of the salary paid to the
employee during the leave period. If you take the credit, you may not also deduct
the salary paid to the donor employee for that period. This credit is not available if
the employee is eligible for leave under the Family and Medical Leave Act of 1993.
Organ and Bone Marrow Donor Credit
— Computation —
Column 1 Column 2 Column 3 Column 4
Credit Category Total Paid Leave Leave Credit Calculation Total Credit
Organ Donor(s) Total Paid Leave Col 2 ______________
Wages amt.
$_______________
x
25% ____________
$__________________ $________________
Bone Marrow Total Paid Leave Col 2 ______________
Donor(s) Wages amt.
$_______________
x
25% ____________
$__________________ $________________
Total of Col. 4.
Enter here and
on Schedule UB.*
$________________
*Line 3 of Schedule UB for D-20 filers
Line 14 of Schedule UB for D-30 filers
1. Number of Eligible Employees
2. Amount of Homeownership Assistance provided
during this period to Eligible Employees ...........................x 50% $
3. Tax Credit .............................................................................. $
(Cannot exceed Line 2 amount and limited to $2,500 per Eligible
Employee)
Enter amount from Line 3 on
Line 7 of Schedule UB for D-20 filers, or
Line 18 of Schedule UB for D-30 filers.
Employer-Assisted Home Purchase Tax Credit
An employer who provides homeownership assistance to eligible employees
through a certified home purchase program may be eligible to claim a credit
against the franchise tax if certain conditions are met. See instructions and
DC Code Section 47-1807.07 for further details.
Employer-Assisted Home Purchase Tax Credit
— Computation —
$0
Government of the
District of Columbia
of Designated Agent
Taxable year ending MM YY
Business mailing address line #2
Business mailing address line #1
Name of Designated Agent
City State Zip Code + 4
Telephone number
A
List the designated agent and all
combined members
D
Is the member new
to the
combined group?
C
Was a separate
DC franchise tax
return filed in the
prior year?
B
Identification Number
E
Was gross income
received from
District sources?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Note: If more than 1 combined members, continue list on a separate sheet of paper.
F
Does the member
have nexus in DC?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Worldwide
2021
NOTE: READ INSTRUCTIONS BEFORE
COMPLETING THIS FORM
*21 *
Important: Print in CAPITAL letters using black ink.
Revised 07/2021
Number of members in the combined group
10002
Print
Clear
Government of the
District of Columbia
Taxpayer Identification Number of Designated Agent Taxable Year YYYY Worldwide
Name of Designated Agent Telephone number
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.
*212300110002*
Revised 07/2021
Print
Clear
Government of the
District of Columbia
2021
SCHEDULE
Property Tax Credit
Important: Read eligibility requirements before completing.
Print in CAPITAL letters using black ink.
Revised 07/2021
elephone number
Landlord’s address (number and street)
City State Zip Code +4
If Owner, enter information from your real property tax bill or assessment. If a section is blank on your property tax bill, leave it blank here.
Square number Suffix number Lot number
Address of DC roperty (number, street and suite number if applicable) for which you are claiming the credit if different from above
Do not claim this credit if your qualified business is exempt from or receives any tax credits towards its real property
tax or the qualified rental retail location or the qualified owned retail location is otherwise exempt from real property
tax.
The credit equals the total Class 2 real property taxes paid by a qualified corporation or qualified unincorporated
business for a qualified retail owned location during the taxable year not to exceed $5,000; or
10% of the total rent
paid by a qualified corporation or qualified unincorporated business for a qualified rental retail location not to exceed
$5,000.
OFFICIAL USE ONLY Vendor ID#0002
Landlord’s name
$ .00
$
.00
$
.00
Fill in
Fill in
if filing a D-20 Return
if filing a D-30 Return
T
axpayer Identification Number
ni lli ni lliF
ni lli ni lliF
Enter your business name
Do not make claim if $2.5m or more.
1 $ .00
2021
2021
2021
$ .00
Mailing address (number, street and suite number if applicable)
City State Zip Code +4
if FEIN
if SSN
Sales and Use Tax Account Number
Certificate of Occupancy Permit Number
If member of a Combined Group, Taxpayer Identification Number of Designated Agent
City
State Zip Code +4
*21SR00110002*
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Form 2021: *210300110002* 0002 (Government of the District of Columbia)

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Completed 28 February 2022

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