FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
1014015105
1014015105
DEPARTMENT USE ONLY
RCT-101D
(FI) (06-15)
Declaration of de minimis Pennsylvania Activity
STEP A
PLEASE ENTER ALL DATES AS MMDDYYYY
START
XX
XX
Tax Year Beginning
Address Change
XX
Tax Year Ending
STEP B
XX
Revenue ID
Parent Corporation EIN
XX
Federal EIN
XX
Corporation Name
XX
Address Line 1
XX
Address Line 2
XX
City
XX
State
XX
ZIP
During the tax period beginning
and ending
, the above-named corporation's activity in the Commonwealth of
Pennsylvania did not exceed the de minimis activities outlined in Part II of Corporation Tax Bulletin 2004-01, issued April 13, 2004, and titled PL 86-272
Interpretation and De Minimis Standards. Based on this activity, this corporation is not required to file a PA franchise tax, loans tax and/or corporate net
income tax report for this period.
Transportation Companies (Truck and Bus Companies)
Non-transportation Companies
Revenue Miles in PA
Number of Days in PA
Revenue Miles Everywhere
Total PA Sales
Trips into PA
The undersigned acknowledges that de minimis levels of activity are sufficient to subject a corporation to tax, but the department has elected not to require
the filing of a tax return based solely upon de minimis activities. Further, for the taxpayer to utilize any tax benefits generated in this period, the taxpayer
will be required to file a complete RCT-101, PA Corporate Tax Report, for this period and pay any tax due.
STEP C:
Corporate Officer (Must sign affirmation below)
NAME
PHONE
EMAIL
I affirm under penalties prescribed by law, this declaration, including any accompanying schedules and statements, has been examined by me and to the best
of my knowledge and belief is a true, correct and complete declaration.
Corporate Officer Signature
Date
PLEASE SIGN THIS RETURN AFTER PRINTING.
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