Form Rev-545ct Pc - Research And Development Tax Credit Application - 2009
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1REV-545CT(5-09)PC
PENNSYLVANIA
BUREAU OF CORPORATION TAXES
PO BOX 280703
RESEARCH AND DEVELOPMENT
HARRISBURG PA 17128-0703
TAX CREDIT
2009 APPLICATION
Account ID (Box Number/SSN)
EIN
ENTITY INFORMATION - (PLEASE PRINT OR TYPE)
«Boxno»
«EIN»
Entity Name
DUE DATE:
«Name»
September 15, 2009
Street Address
Department Use Only
«Address1»
POST MARK DATE:
«Address2»
SEE INSTRUCTIONS ON REVERSE SIDE
City or Town, State, and ZIP Code
BEFORE COMPLETING
«City», «St» «Zip»
CHECK BOX IF A SMALL BUSINESS
IF CLAIM IS AS A SMALL BUSINESS WITH TOTAL ASSETS OF LESS THAN $5 MILLION AT THE BEGINNING OR END OF THE YEAR,
SUBMIT A BALANCE SHEET REFLECTING TOTAL ASSETS.
ENTER ENTITY TYPE (SEE INSTRUCTIONS ON BACK) _______________
KOZ - (SEE INSTRUCTIONS ON BACK)
CALCULATION OF CREDIT
1. Pennsylvania qualified research and development (R&D) expenditures:
Use Whole Dollars
Tax Year Beginning
Tax Year Ending
Actual
Annualized
MM/DD/YYYY
MM/DD/YYYY
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
$__________________ ............................................ 1.$ __________________
2. 50 percent of Line 1 ..............................................................................................................................................................2.$__________________
3. Prior years' Pennsylvania R&D expenditures:
Tax Year Beginning
Tax Year Ending
Actual
Annualized
MM/DD/YYYY
MM/DD/YYYY
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
$__________________ 3A. $__________________
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
$__________________ 3B. $__________________
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
$__________________ 3C. $__________________
__ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
$__________________ 3D. $__________________
4. Total of prior years’ annualized Pennsylvania R&D expenditures (Sum of 3A, 3B, 3C and 3D) …………..… 4. $__________________
5. Average of prior years' Pennsylvania R&D expenditures
(Line 4 divided by number of base years in Line 3 with R&D expenditures)…………………………. 5. $____________________
6. Line 1 minus the greater of Line 2 or Line 5…………………………………………………...………………. 6. $____________________
7. Tentative Pennsylvania R&D credit (Line 6 x 0.1 or 0.2 for large or small company, respectively)……….…... 7. $____________________
SIGNATURE AND VERIFICATION
Under penalties of perjury, I declare I have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief it is true,
correct and complete. THIS FORM MUST BE SIGNED BY A CORPORATE OFFICER.
SIGNATURE OF OFFICER OF COMPANY
FAX NUMBER
DATE
MM/DD/YYYY
PLEASE SIGN AFTER PRINTING FORM
(
)
PRINT OFFICER'S NAME
TITLE
TELEPHONE NUMBER
E-MAIL ADDRESS
(
)
NAME OF PREPARER
PREPARER'S ADDRESS
TELEPHONE NUMBER
PREPARER'S EIN OR SSN
DATE
MM/DD/YYYY
CITY
STATE
ZIP CODE
(
)
PRINT FORM
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