Form Pa-8879-P - Pennsylvania E-File Signature Authorization For Pa S Corporation/partnership Information Return (Pa-20s/pa-65) - Directory Of Corporate Partners (Pa-65 Corp) - 2016

Pennsylvania E-File Signature Authorization for

PA-8879-P (05-16)

PA-8879-P

2016

PA S Corporation/Partnership Information Return

(PA-20S/PA-65) - Directory of Corporate Partners (PA-65 Corp)

Form

Federal Employer Identification

Number (FEIN)

For calendar year 2016 or tax year beginning

, 2016, ending

, 20___

Name of Entity

Entity Address

City

State

ZIP Code

Revenue ID

Part I

Tax Return Information. Enter whole dollars only.

1. Calculate Adjusted/Apportioned Net Business Income (Loss) (PA-20S/PA-65, Part II, Line 2d)

2. Calculate Adjusted/Apportioned Net Business Income (Loss) (PA-20S/PA-65, Part II, Line 2h)

3. Total Other PA PIT Income (Loss) (PA-20S/PA-65, Part III, Line 9)

4. Total PA Income Tax Withheld (PA-20S/PA-65, Part V, Line 14c)

5. Total Corporate Net Income Tax Withholding For All Nonfiling Corporate Partners For This Entity

(PA-65 Corp, Line 4)

Part II

Declaration and Signature Authorization of General Partner, Limited Liability Company Member, S Corporation

Officer, Authorized Partner or Representative. Keep a copy of the entity’s return.

Under penalties of perjury, I declare I am a general partner, limited liability company member, S corporation officer, authorized partner or representative

of the above entity and I have examined a copy of the entity's 2016 electronic return and accompanying schedules and statements. To the best of my

knowledge and belief, all are true, correct and complete. I further declare the amounts in Part I above are the amounts shown on the copy of the entity's

electronic return. I consent to allow my electronic return originator (ERO) and/or transmitter to send the entity's return to the PA Department of Revenue

and receive from the PA Department of Revenue an acknowledgement of receipt of transmission and an indication of whether or not the entity’s return is

accepted, and, if rejected, the reason(s) for rejection of the transmission. If applicable, I authorize the PA Department of Revenue and its designated

financial institution to initiate an electronic funds withdrawal from the account indicated in the tax preparation software for payment of the state withholding

liability owed on this return, and I authorize the financial institution to debit the entry to this account. I understand that the federal Office of Foreign Assets

Control has imposed additional reporting requirements on all electronic banking transactions that directly involve a financial institution outside of the

territorial jurisdiction of the U.S. These transactions are called international ACH transactions (IAT). I understand that presently, the PA Department of

Revenue does not support IAT ACH debit transactions. I certify that the transactions do not directly involve a financial institution outside of the territorial

jurisdiction of the U.S. at any point in the process. To revoke a payment, I must contact the PA Department of Revenue by email to ra-achrevok@pa.gov

or fax at 717-772-9310 no later than two business days prior to the debit date. I also authorize the financial institutions involved in the processing of the

electronic payment of withholding to receive confidential information necessary to answer inquiries and resolve issues related to the payment. If I have a

balance-due return, I understand if the PA Department of Revenue does not receive full and timely payment of my withholding liability, I will remain liable

for the withholding liability and all applicable interest and penalties. If I have filed a joint federal and state tax return and there is an error on my federal

return, I understand my state return will be rejected. If my return is rejected or if any other delay in filing occurs, I understand I will remain liable for all

applicable interest and penalties. I have selected a federal self-select PIN as my signature for the entity's electronic return and, if applicable, the entity's

consent to electronic funds withdrawal.

General partner, limited liability company member, S corporation officer, authorized partner or representative’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 entity’s 2016 electronically filed return.

As a general partner, limited liability company member, S corporation officer, authorized partner or representative of the entity, I will

enter my federal self-select PIN as my signature on the entity’s 2016 electronically filed return.

Authorized Signature

Date

Title

Social Security Number

Address

City

State

ZIP Code

Part III Certification and Authentication

ERO’s EFIN/PIN. Enter your six-digit e-File Identification Number followed by your

five-digit federal self-selected PIN.

Do not enter all zeros.

I certify the above numeric entry is my federal self-selected PIN, which is my signature on the 2016 electronically filed return for the entity indicated above.

I confirm I am participating in the Practitioner PIN Program in accordance with the requirements established for this program.

I certify that the financial institution for the withdrawal of funds is within the territorial jurisdiction of the U.S.

ERO’s Signature

_____________________________________________________________________________________________________________ Date

_________________________________

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

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