Form Pa-41a - Pa-41 Schedule A - Interest Income And Gambling And Lottery Winnings - 2015
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11504310051
PA-41 SCHEDULE A
Interest Income and Gambling
and Lottery Winnings
2015
OFFICIAL USE ONLY
PA-41A (08–15) (FI)
Name as shown on the PA-41
Federal EIN or Decedent’s SSN
START
Caution: If the estate or trust’s total PA-taxable interest income is equal to the amount reported on the estate or trust’s federal Form
1041 and there are no amounts for Lines 2 through 14 (not including subtotal Lines 4 and 10) of Schedule A, the estate or trust must
report the interest income on Line 1 of the PA-41, Fiduciary Income Tax Return, but the estate or trust does not have to submit
Schedule A. If there are any amounts for any of the Lines 2 through 14 (not including subtotal Lines 4 and 10) of Schedule A,
the estate or trust must complete and submit Schedule A with the estate or trust’s PA-41, Fiduciary Income Tax Return.
1. Interest income reported on federal Form 1041 Line 1.
1. $
2. Total tax-exempt interest income.
2. $
3. Other addition adjustments. See instructions.
Description:
3. $
4. Add Lines 1, 2 and 3.
4. $
5. Interest income from federal Schedule(s) K-1. See instructions.
5. $
6. Interest income from direct obligations of the Commonwealth of Pennsylvania
and/or its municipalities.
6. $
7. Interest income from direct obligations of the U.S. government.
7. $
8. Other reduction adjustments. See instructions.
Description:
8. $
9. Add Lines 5, 6, 7 and 8.
9. $
10. Subtract Line 9 from Line 4.
10. $
11. Distribution from life insurance, annuity, endowment contracts, or charitable gift
annuities included in federal taxable income. See instructions.
11. $
12. Interest income from partnership(s), from PA Schedule(s) RK-1 or federal
Schedule(s) K-1.
12. $
13. Interest income from PA S corporation(s), from PA Schedule(s) RK-1 or federal
Schedule(s) K-1.
13. $
14. Gambling and lottery winnings. See instructions.
14. $
15. Total interest income and gambling and lottery winnings
Add Lines 10, 11, 12, 13, and 14. Enter on Line 1 of the PA-41.
15. $
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