Form Rct-143 - Net Income Tax Report Mutual Thrift Institutions Page 2

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1430012205

Revenue ID

RCT-143

(09-14)

PAGE 2 OF 4

CALCULATION OF NET INCOME TAX

USE WHOLE DOLLARS ONLY

Income from Financial Statements

Deductions

Interest from U.S. Obligations

Interest from PA Obligations

Total Deductions (Line 2 plus Line 3)

Additions

Interest Expense Allocable to Tax-Exempt Income (from Schedule B, Line 5)

Employment Incentive Payment Credit

Total Additions (Line 5 plus Line 6)

Income to be Apportioned to PA (Line 1 minus Line 4 plus Line 7)

Apportionment (from Schedule C, Line 16)

10. Income Apportioned to PA (Line 8 times Line 9)

10.

11. Net Loss Deduction (from Schedule A, Column D total)

11.

12. Taxable Income (Line 10 minus Line 11)

12.

13. Tax (Line 12 times tax rate – See Instructions)

13.

1430012205

Preparer’s Information:

Firm Name

Individual Preparer Name

Firm FEIN

Phone

Address

City

Social Security Number

or PTIN

State

ZIP

I affirm under penalties prescribed by law this report, including any accompanying schedules and statements, has been prepared by me and to the best of my

knowledge and belief is a true, correct and complete report.

Signature of Preparer

Date

Signature of Preparer – Please sign after printing

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