Form Rct-112 - Gross Receipts Tax Report Electric, Hydro-Electric And Water Power Companies -Commonwealth Of Pennsylvania Department Of Revenue Page 4
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4SETTLEMENT PAGE
PENNSYLVANIA GROSS RECEIPTS TAX
ELECTRIC, HYDRO-ELECTRIC AND WATER POWER COMPANIES
RECEIVED
DLN
ACCOUNT ID
TAX PERIOD ENDING
MAILED
MAILING INSTRUCTIONS
Mail settlement of this report to:
Name
Street
(CITY)
(STATE)
(ZIP CODE)
DO NOT WRITE BELOW THIS LINE
SETTLEMENT - GROSS RECEIPTS TAX
(Official)
TYPE OF TAX
10
To Tax on GROSS RECEIPTS for the 12 months ended
19
SELF ASSESSED TAX
GROSS RECEIPTS TAXABLE
$
TAX DEBIT OR CREDIT
TOTAL TAX
Tax at the rate of 44 mills
PENALTY DEBIT
210
Penalty (for failure to file report within time limit prescribed by law)
DEPARTMENT OF REVENUE
DEPARTMENT OF AUDITOR GENERAL
Harrisburg, PA
19
Harrisburg, PA
19
SETTLED AND DELIVERED TO AUDITOR GENERAL:
AUDITED AND APPROVED:
(FOR THE SECRETARY OF REVENUE)
(FOR THE AUDITOR GENERAL)
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