Looking for a Pennsylvania Tax Forms And Templates? Download it for free!

PENNSYLVANIA e-file SIGNATURE AUTHORIZATION

FOR CORPORATE TAX REPORT RCT-101

Form PA-8879-C

See instructions.

2011

For calendar year 2011 or tax year beginning

, 2011, ending

, 20___.

Name of Corporation

Employer Identification Number

Corporation Address

City

State

ZIP Code

PA Tax Account ID Number

PART I

TAX REPORT INFORMATION (Whole dollars only.)

1. Total Book Income (Form RCT-101, Section A, Line 2)

2. Capital Stock/Foreign Franchise Tax (Form RCT-101, Section A, Line 18)

3. Income or Loss from Federal Return on a Separate Company Basis (Form RCT-101, Section C, Line 1)

4. PA Taxable Income or Loss (Form RCT-101, Section C, Line 12)

5. Corporate Net Income Tax (Form RCT-101, Section C, Line 13)

PART II

DECLARATION AND SIGNATURE AUTHORIZATION OF OFFICER (Keep a copy of the corporation's tax report.)

Under penalties of perjury, I declare I am an officer of the above-named corporation and I examined a copy of the corporation's 2011 electronic tax

report, accompanying schedules and statements, and to the best of my knowledge and belief they are true, correct and complete. I further declare

the amounts in Part I above are the amounts shown on the copy of the corporation's electronic tax report. I consent to allow my electronic return

originator (ERO) and/or transmitter to send the corporation's report to the PA Department of Revenue and receive from the PA Department of Revenue

an acknowledgement of receipt or reason for rejection of the transmission. If applicable, I authorize the PA Department of Revenue and its designat-

ed financial institution to initiate an electronic funds withdrawal entry to the financial institution account indicated in the tax preparation software for

payment of the corporation's state taxes owed on this report, and I authorize the financial institution to debit the entry to this account. To revoke a

payment, I must contact the PA Department of Revenue no later than two business days prior to the payment date by calling 717-783-6277. I also

authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer

inquiries and resolve issues related to the payment. I selected a federal self-select PIN as my signature for the corporation's electronic tax report and,

if applicable, the corporation's consent to electronic funds withdrawal.

Officer’s Federal Self-Select PIN (check one box only):

_______________

I authorize ________________________________________________ to enter my federal self-select PIN

as my signature

ERO firm name

Do not enter all zeros.

on the corporation’s electronically filed tax report.

As an officer of the corporation, I will enter my federal self-select PIN as my signature on the corporation’s electronically filed tax report.

Officer’s Signature

Date

Title

Social Security Number

Address

City

State

ZIP Code

PART III CERTIFICATION AND AUTHENTICATION

ERO’s EFIN/PIN (Enter your six-digit EFIN followed by your five-digit federal self-select PIN.):

Do not enter all zeros.

As a participant in the Practitioner PIN Program, I certify the above numeric entry is my federal self-select PIN, which is my signature on the tax year

2011 electronically filed corporate tax report for the taxpayer(s) indicated above. I confirm I am participating in the Practitioner PIN Program in accor-

dance with the requirements established for this program.

ERO’s Signature 4 _______________________________________________________________________________________________ Date 4_________________________________

ERO must retain this form and the supporting documents for three years.

DO NOT SUBMIT THIS FORM TO THE PA DEPARTMENT OF REVENUE UNLESS REQUESTED TO DO SO.