Form Rct-113a - Gross Receipts Tax (Grt) Report Transportation Company (Other Than Motor Vehicle) Page 2

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1130012205

Revenue ID

RCT-113A

PAGE 2 OF 3

(06-12)

SOURCE OF GROSS RECEIPTS

USE WHOLE DOLLARS ONLY

Transportation of freight, baggage, oil and /or passengers:

1a. From points within the state to points within the state

1a.

1b. Between points inside the state and outside the state

1b.

1c. Totally outside the state

1c.

Carrying of U.S. mail

Equipment rental income from other transportation companies (Attach Explanation)

All other rental income

Dividends and Interest

Gross Royalties

Capital Gain Net Income

Net Gains or Losses

All other sources (Attach a schedule with explanation)

10. Total PA Taxable Gross Receipts

10.

11. Gross Receipts Tax (Line 10 times tax rate – See Instructions)

11.

Other Information:

12a. Type of Entity (A=Pipeline, B=Conduit, C=Steamboat, D=Canal,

12a.

E=Slack Water Navigation, F=Transportation, G=Other)

12b. If G, list other:

12b.

13a. Federal Return filed (A=1120, B=1065, C=Schedule C, D=Other)

13a.

13b. If D, list other:

13b.

Summary from Page 3:

14. Total Gross Receipts (from Page 3, Column, A, Line 10)

14.

15. Gross Receipts from Business Conducted in Other States

15.

(from Page 3, Column B, Line 10)

16. Adjustment for PA bad debts plus PA Non-taxable Sales (from Page 3, total

16.

of Column C, Line 10 plus Column D, Line 10)

*1 1 3001 2205*

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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