FILL IN FORM USING ALL CAPS
DO NOT PLACE ANY DASHES (-) OR SLASHES (/) IN THE FIELDS
1019012105
*1 01 901 21 05*
DEPARTMENT USE ONLY
INACTIVE
START
20_ _
RCT-101-I
PAGE 1 OF 3 INACTIVE PA CORPORATE TAX REPORT
(FI) (06-12)
PLEASE ENTER ALL DATES AS MMDDYYYY
STEP A
XX
XX
Tax Year Beginning
Tax Year Ending
STEP B
XX
XX
XX
52-53 Week Filer
Change Fed Group
File Period Change
XX
XX
Address Change
First Report
STEP C
XX
Revenue ID
Parent Corporation EIN
XX
Federal EIN
XX
Corporation Name
XX
Address Line 1
XX
Address Line 2
XX
City
XX
State
XX
ZIP
USE WHOLE DOLLARS ONLY
STEP E:
B. Estimated
Payment Due/Overpayment
STEP D
A. Tax Liability
C. Restricted
Payments &
Calculation: A minus B minus C
from Tax Report
Credits
Credits on Deposit
See Instructions
0
CS/FF
0
LOANS
0
CNI
0
TOTAL
STEP F: Transfer/Refund Method: See Instructions
E-File Opt Out: See Instructions
Transfer: Amount to be credited to the next
tax year after offsetting all unpaid liabilities
Refund: Amount to be refunded after
offsetting all unpaid liabilities
STEP G: Corporate Officer (Sign affirmation below)
NAME
PHONE
FORM
EMAIL
BARCODE
I affirm under penalties prescribed by law this report, including any accompanying schedules and statements, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete report.
Corporate Officer Signature
Date
PLEASE SIGN THIS RETURN AFTER PRINTING.
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