Form Rct-113 - Gross Receipts Tax Report Transportation Business - Commonwealth Of Pennsylvania Department Of Revenue Page 2

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SETTLEMENT COMPUTATION
PENNSYLVANIA GROSS RECEIPTS TAX REPORT
TRANSPORTATION BUSINESS OTHER THAN MOTOR VEHICLE
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
SELF ASSESSED TAX
To Tax on GROSS RECEIPTS for the 12 months ended
19
TAX DEBIT OR CREDIT
GROSS RECEIPTS TAXABLE
$
TOTAL TAX
Tax at the rate of 50 Mills (.050)
Penalty (for failure to file report within time limit prescribed by law)
PENALTY DEBIT
210
DEPARTMENT OF REVENUE
DEPARTMENT OF AUDITOR GENERAL
Harrisburg, PA
19
Harrisburg, PA
l9
SETTLED AND DELIVERED TO AUDITOR GENERAL:
AUDITED AND APPROVED:
(FOR THE SECRETARY OF REVENUE)
(FOR THE AUDITOR GENERAL)

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