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4 State of Rhode Island Division of Taxation 4
5 RI-1120C - CGM Schedule 5
6 Combined Group Member Listing 23113799990101 6
7 7
8 Name Federal employer identification number 8
9 9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999 10
11 11
12 This schedule is to be filed with Form RI-1120C. 12
13 13
14 If this filing is based on a Federal Consolidated return, check the "Federal consolidated election" checkbox to the right. 14
15 15
16 List the name, federal employer identification number and address for each Combined Group Member. 16
17 Top row: street address 17
18 Combined Group Member (CGM) CGM FEIN CGM Address 18
Bottom row: city, state, ZIP
19 19
20 1 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 20
21 21
22 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 22
23 23
24 2 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 24
25 25
26 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 26
27 27
28 3 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 28
29 29
30 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 30
31 31
32 4 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 32
33 33
34 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 34
35 35
36 5 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 36
37 37
38 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 38
39 39
40 6 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 40
41 41
42 If this Combined Group Member has nexus, check this box:DRAFT DRAFT XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 42
43 43
44 7 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 44
45 45
46 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 46
47 47
48 8 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 48
49 49
50 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 50
51 51
52 9 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 52
08/22/202309/20/2021
53 53
54 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 54
55 55
56 10 XXXXXXXXXXXXXXXXXXXXXXXXXX 999999999 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 56
57 57
58 If this Combined Group Member has nexus, check this box: XXXXXXXXXXXXXXXXXXXXXXXXXXXXX 58
59 59
Combined schedules must be attached to the return.
60 60
61 61
62 62
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