Form Rct-111 - Gross Receipts Tax (Grt) Report Telecommunications Page 3
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71110012305
RCT-111
(06-12)
PAGE 3 OF 7
GROSS RECEIPTS TAX - TELECOMMUNICATIONS
Taxpayer Name
Revenue ID
PA SALES FOR RESALE EXEMPTION SCHEDULE
12/31/20
FOR TAX YEAR:
USE WHOLE DOLLARS ONLY
(A)
(B)
(C)
Name of
PA Sales
Intrastate (11)
Interstate (12)
Mobile (13)
Reseller
Tax Number
FEIN
Gross Receipts
Gross Receipts
Gross Receipts
(Column A)
(Column B)
(Column C)
Totals
*1 1 1 001 2305*
Grand Total (Sum of Columns A, B and C)
Notice to Taxpayer: Allowance of the Sales for Resale Exemption is contingent on the validation
of the listed entities’ subjectivity to gross receipts tax.
1110012305
1110012305
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