Form Rct-125 - Cooperative Agriculture Association Corporate Net Income Tax Report Page 4

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Page 4
PENNSYLVANIA COOPERATIVE AGRICULTURE ASSOCIATION
RECEIVED
CORPORATE NET INCOME TAX REPORT
CALCULATED
DLN
ACCOUNT ID
TAX PERIOD ENDING
MAILED
MAILING INSTRUCTIONS
Mail settlement on account of this report to:
Name
Street
(CITY)
(STATE)
(ZIP CODE)
DO NOT WRITE BELOW THIS LINE
SETTLEMENT
CORPORATE NET INCOME TAX
(Official)
TYPE OF TAX
80
To tax on Corporate Net Income for the twelve months ended
SELF ASSESSED TAX
Amount of Net Income wholly taxable in Pennsylvania . . . . . . . . . . . . $
Computation of Net Income Allocable to Pennsylvania
TAX DEBIT OR CREDIT
$
=
$
Net Income to be Allocated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
TOTAL TAX
Total Taxable Income in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . .$
Tax at rate of four percent (4%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PENALTY DEBIT
280
Penalty (for failure to file report within time limit prescribed by law) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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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