FILL IN FORM USING ALL CAPS
DO NOT PLACE ANY DASHES (-) OR SLASHES (/) IN THE FIELDS
1283014105
1283014105
DEPARTMENT USE ONLY
RCT-128C
(FI) (08-14)
PAGE 1 OF 3
REPORT OF CHANGE IN CORPORATE NET INCOME TAX
PLEASE ENTER ALL DATES AS MMDDYYYY
STEP A
START
XX
XX
Tax Year Beginning
Tax Year Ending
STEP B
XX
XX
XX
52-53 Week Filer
Address Change
PA S Corporation
XX
XX
XX
Regulated Inv. Co./
Taxable Built-in Gains
KOZ/EIP Credit
Sub Paragraph 18
STEP C
XX
Parent Corporation EIN
Revenue ID
XX
Federal EIN
XX
Business Activity Code
XX
Corporation Name
XX
Address Line 1
XX
Address Line 2
XX
City
XX
State
XX
ZIP
USE WHOLE DOLLARS ONLY
STEP D
As required by Section 406 of the Tax Reform Code of 1971, the above-named corporation reports the following change(s) or correction(s) in its
corporate net income as reported to or changed by the federal government.
1.
PA taxable income after change or correction in federal return
1
2
2.
PA taxable income previously reported to the commonwealth
2A
A. Increase or decrease in PA taxable income
3
3.
PA corporate net income tax after change
4
4.
PA corporate net income tax before change
4A
A. Increase or decrease in PA corporate net income tax
5
5.
Remittance made payable to the PA Department of Revenue
04 CNI 121101
STEP E: Transfer/Refund Method (See instructions.)
Transfer: Amount to be credited to the next tax year after offsetting all unpaid liabilities
Refund: Amount to be refunded after offsetting all unpaid liabilities
NOTICE OF FINAL CHANGE WAS RECEIVED FROM THE INTERNAL REVENUE SERVICE OR AMENDED FEDERAL RETURN FILED ON
NOTE: If the date is not provided, interest will be imposed from the original due date applicable to that tax year.
STEP F: Corporate Officer (Sign affirmation below.)
NAME
PHONE
FORM
EMAIL
BARCODE
I affirm under penalties prescribed by law, this report, including the accompanying explanations, is made in good faith and is a true
and correct statement of the PA taxable income after final changes or corrections, as determined or accepted by the federal government,
to the corporation’s federal income tax return for the period.
Corporate Officer Signature
Date
PLEASE SIGN THIS RETURN AFTER PRINTING.
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