Form Rct-101 - Pa Corporate Net Income Tax Report - 2016

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FILL IN FORM USING ALL CAPS.

DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1 1

161 5

1010016105

DEPARTMENT USE ONLY

RCT-101

page 1 oF 4

2016

(FI) (08-16)

pa CoRpoRaTe NeT INCoMe Tax RepoRT

START

IRs Filing Type

A = 1120

B = 1120S

C = Other

PLEASE ENTER ALL DATES AS MMDDYYYY

sTep a

Tax Year Beginning

Tax Year Ending

sTep B

Amended Report

52-53 Week Filer

First Report

File Period Change

Federal Extension Granted

Address Change

KOZ/EIP/SDA Credit

S Corp Taxable Built-in Gains

Change Fed Group

Royalty/Related Interest

Regulated Inv. Co./

Add-Back (Act 52 of 2013)

Sub Paragraph 18

sTep C

Revenue ID

Parent Corporation EIN

Federal EIN

Business Activity Code

Corporation Name

Address Line 1

Address Line 2

City

Province

State

Country Code

ZIP

Foreign Postal Code

sTep D: pa CoRpoRaTe NeT INCoMe Tax

use whole DollaRs oNly

sTep e:

payment Due/overpayment

a. Tax liability

B. estimated

C. Restricted

from page 2

payments &

Calculation: A minus B minus C

Credits

(can not be less than zero)

Credits on Deposit

See instructions.

CNI

e-File opt out (see instructions.)

sTep F: Transfer/Refund Method (see instructions.)

Transfer: Amount to be credited to the next

tax year after offsetting all unpaid liabilities.

Refund: Amount to be refunded after

offsetting all unpaid liabilities.

sTep g: Corporate officer (Must sign affirmation below)

NaMe

phoNe

FoRM

BaRCoDe

I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief

is a true, correct and complete report. If this report is an amended report, the taxpayer hereby consents to the extension of the assessment period for this tax year to one year from

the date of filing of this amended report or three years from the filing of the original report, whichever period last expires, and agrees to retain all required records pertaining to that

tax and tax period until the end of the extended assessment period, regardless of any statutory provision providing for a shorter period of retention. For purposes of this extension,

an original report filed before the due date is deemed filed on the due date. I am authorized to execute this consent to the extension of the assessment period.

Corporate officer signature

Date

PLEASE SIGN AFTER PRINTING.

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