Form Rct-101 - Pa Corporate Tax Report Page 6

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1010012605
REVENUE ID
TAX YEAR END
NAME
RCT-101
PAGE 6 OF 6
PA CORPORATE TAX REPORT 20_ _
(FI)
SCHEDULE OF REAL PROPERTY IN PA (Attach a separate schedule if additional space is needed.)
O = Own
R = Rent
Street Address
City
County
KOZ/KOEZ
XX
XX
XX
XX
CORPORATE OFFICERS
SSN
Last Name
First Name
MI
(See Instructions.)
XX
President/Managing Partner
XX
Vice President
XX
Secretary
XX
Treasurer/Tax Manager
PREPARER’S INFORMATION
XX
Mail to Preparer
XX
Firm Federal EIN
XX
Firm Name
XX
Address Line 1
XX
Address Line 2
XX
City
XX
State
XX
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
EMAIL
PTIN/SSN
PRINT FORM
Reset Entire Form
RETURN TO TOP
RETURN TO PAGE ONE
*1 01 001 2605*
1010012605

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