STATE OF MARYLAND
STATE OF MARYLAND
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
COMPTROLLER'S VERIFICATION FORM
DATE:
TO: Kim Foster
kfoster@comp.state.md.us
AGENCY: COMPTROLLER'S OFFICE
PHONE: (410) 767-1908
FAX #: (410) 333 - 7499
FROM:
FAX #:
VOICE TELEPHONE #:
MESSAGE: PLEASE PROVIDE THE REQUESTED INFORMATION REGARDING:
Name
Address:
FEIN/SSN:
For use by the Comptroller's Office
Is this firm registered to do business in Maryland: Yes No
as a Foreign / Domestic corporation?
Are there any existing tax liabilities: Yes No
Notes:
Firm's Resident Agent:
Comptroller's Office Control Number:
THIS INFORMATION MAY BE RETURNED ELECTRONICALLY to
THANK YOU FOR YOUR ASSISTANCE.
(Rev. 05/10)
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