Form Rev-976 - Election Not To Be Taxed As A Pennsylvania S Corporation

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REV-976 (05-12)
BUREAU OF CORPORATION TAXES
PA S UNIT
ELECTION NOT TO BE TAXED AS
PO BOX 280705
HARRISBURG PA 17128-0705
A PENNSYLVANIA S CORPORATION
Corporation is not subject to
PA corporate taxes; election is for PA
START
resident shareholder purposes only.
Revenue ID
Federal ID (EIN)
Election is to be first effective for:
Tax year beginning:
MM DD YYYY
Please fill in Corporate Name, Address, City, State and ZIP Code Above.
Election is for this corporation and its qualified subchapter S
Tax year ending:
MM DD YYYY
subsidiaries as identified on the attached schedule showing the names
and Revenue ID numbers of all subsidiaries.
(B)
(C)
(D)
Social Security
We, the undersigned
(A)
Name and address of each shareholder, member or partner having an
Number or Federal
Percentage
shareholders, consent to the
interest in the corporation’s stock without regard to the manner in which
Employer
of
election of the corporation not
the stock is owned. If additional space is needed, complete a separate
Identification
Stock
to be taxed as a
schedule and attach it to this form.
Number
Owned
Pennsylvania S corporation.
You must provide your Social Security number so the department may
establish your identity and cross-reference other tax systems, as is
authorized under federal law, 42 U.S.C. § 405 (c).
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci ty
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Code
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
MMDDYYYY
Name
Signature/Date
Street
Ci t y
State
ZIP Cod e
Please Sign after printing.
Total = _____ 100%
NAME OF CORPORATE OFFICER
TELEPHONE NUMBER
The corporate statement must be signed by an authorized officer of the corpora-
tion. The above-named corporation hereby elects not to be taxed as a
Á
Pennsylvania S corporation under Section 401 of the Tax Reform Code of 1971.
SIGNATURE AND TITLE
Please Sign after printing.
Under penalties of perjury, I declare that I have examined this Election Not
SOCIAL SECURITY NUMBER
DATE
To Be Taxed As A Pennsylvania S Corporation form, and to the best of my
MMDDYYYY
knowledge and belief it is true, correct and complete.
Reset Entire Form
PRINT FORM
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