Form Pa-40 Schedule P - Refund Donations To Pennsylvania 529 College Savings Program Accounts - 2016

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PA SCHEDULE P
16
71
55
Refund Donations to
Pennsylvania 529 College
Savings Program Accounts
PA-40 Schedule P
(08-16) (FI)
2016
OFFICIAL USE ONLY
Name shown first on the PA-40 (if filing jointly)
Social Security Number (shown first)
CAUTIONS Pennsylvania 529 College Savings Program (PA 529) account numbers must be included or the donation(s) will not be made as requested.
If a donation cannot be made, a refund will be issued for the amount of the requested donation(s). Donations can only be made to PA 529 Accounts.
Total PA 529 Account donations – plus all other donations on Lines 32 through 36 of the PA-40, cannot exceed the amount on PA-40 Line 29.
1. PA 529 Account Number
Refund Donation
$
First Name of Beneficiary
Last Name of Beneficiary
2. PA 529 Account Number
Refund Donation
$
First Name of Beneficiary
Last Name of Beneficiary
3. PA 529 Account Number
Refund Donation
$
First Name of Beneficiary
Last Name of Beneficiary
4. PA 529 Account Number
Refund Donation
$
First Name of Beneficiary
Last Name of Beneficiary
5. PA 529 Account Number
Refund Donation
$
First Name of Beneficiary
Last Name of Beneficiary
If more than five PA 529 Account donations, please complete and submit additional schedules.
1600710055
16
71
55
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