Form Rct-128c - Report Of Change In Corporate Net Income Tax Page 3

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1283012305

REVENUE ID

TAX YEAR END

NAME

RCT-128C

PAGE 3 OF 3 REPORT OF CHANGE IN CORPORATE NET INCOME TAX

(FI)

DETERMINATION OF APPORTIONMENT PERCENTAGES

From RCT-106, applicable for the tax year being reported

SCHEDULE C-1: Apportionment Schedule For Corporate Net Income Tax (Include Form RCT-106.)

Three-Factor

Property - PA

Property - Total

Payroll - PA

Payroll - Total

Sales - PA

Sales - Total

Single-Factor

Numerator

Denominator

Apportionment

Proportion

PREPARER’S INFORMATION

Mail to Preparer

Firm Federal EIN

Firm Name

Address Line 1

Address Line 2

City

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.

Tax Preparer’s Signature

Date

PLEASE SIGN AFTER PRINTING.

INDIVIDUAL PREPARER

PHONE

PTIN/SSN

PRINT FORM

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