Form Pa-20s/pa-65 - Pa S Corporation/partnership Information Return - 2014 Page 2

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1406110054

PA-20S/PA-65

2014

PAGE 2 of 3

(05-14) (FI)

START

FEIN

9 DIGIT - NO DASH

Business Name

Part IV. Total PA S Corporation or Partnership Income (Loss)

LOSS

Total Income (Loss) per Books and Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LOSS

Total Reportable Income (Loss). Add Lines 1e and 9 or Add Lines 2h and 9 . . . . . . . . . . . . . . . . .

LOSS

Total Nontaxable/Nonreportable Income (Loss). Subtract Line 11 from Line 10 . . . . . . . . . . .

Part V. Pass Through Credits - See the PA-20S/PA-65 instructions

If a loss, enter "0"

13a Total Other Credits. Submit PA-20S/PA-65 Schedule OC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a

If a loss, enter "0"

13b Resident Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b

If a loss, enter "0"

14a PA 2014 Quarterly Tax Withholding Payments/Extension Payment for Nonresident Owners . . . . . . 14a

If a loss, enter "0"

14b Final Payment of Nonresident Withholding Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b

If a loss, enter "0"

14c Total PA Income Tax Withheld. Add Lines 14a and 14b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c

Part VI. Distributions - See the PA-20S/PA-65 instructions – Partnerships Only

If a loss, enter "0"

Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

If a loss, enter "0"

Guaranteed Payments for Capital or Other Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

If a loss, enter "0"

All Other Guaranteed Payments for Services Rendered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

If a loss, enter "0"

Guaranteed Payments to Retired Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Distributions - See the PA-20S/PA-65 instructions – PA S Corporations Only

If a loss, enter "0"

Distributions from PA Accumulated Adjustments Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

If a loss, enter "0"

Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Part VII. Other Information – See the PA-20S/PA-65 instructions for each line

Yes or No

During the entity’s tax year, did the entity own any interest in another partnership or in any foreign entity that was

disregarded as an entity separate from its owner under federal regulations Sections 301.7701-2 and 301.7701-3?

If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Does the entity have any tax-exempt partners/members/shareholders? If yes, submit statement . . . . . . . . . . . . . . . . 2

Does the entity have any foreign partners/members/shareholders (outside the U.S.)? If yes, submit statement . . . . . 3

Was there a distribution of property or a transfer (e.g., by sale or death) of a partner/member interest during the

tax year? (Partnership only) If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Has the federal government changed taxable income as originally reported for any prior period? If yes, indicate

period on supplemental statement, and submit final IRS determination paperwork . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Does the entity have any foreign operations or ownership in a foreign bank account? If yes, submit statement . . . . 6

Is this entity involved in a reportable transaction, listed transaction, or registered tax shelter within this return?

If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Does the entity filing as a partnership have other partnerships as partners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Has the entity sold any tax credits? If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Has the entity changed its method of accounting for federal income tax purposes during this tax year? If yes,

submit federal Form 3115 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Has the entity entered into any like-kind exchanges under IRC Section 1031? If yes, submit federal Form 8824 . . 11

PA Apportionment as reported on PA-20S/PA-65 Schedule H-Corp . . . . . . . . . . . . . . . . . . . . . . . . . 12

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1406110054