Form Pa-20s/pa-65 - Pa S Corporation/partnership Information Return - 2012 Page 3

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1206210054
PA-20S/PA-65
2012
PAGE 3 of 3
(05-12) (FI)
FEIN
9 DIGIT - NO DASH
Business Name
START
C
Part VIII. PA S Corporations Only - Accumulated Adjustments Account (AAA)
and Accumulated Earnings and Profits (AE&P)
AAA
AE&P
LOSS
If a loss, enter "0"
1 Balance at the beginning of the taxable year . . . . If AAA is negative, fill in the oval
1
If a loss, enter "0"
2 Total reportable income from Part IV, Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
N/A
If a loss, enter "0" If a loss, enter "0"
3 Other additions. Submit an itemized statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
LOSS
4 Loss from Part IV, Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
N/A
LOSS
If a loss, enter "0"
5 Other reductions. Submit an itemized statement . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
LOSS
6 Sum of Lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
LOSS
8 Balance at taxable year-end. Subtract Line 7 from Line 6 . . . . . . . . . . . . . . . . . . . . . . .
8
Part IX. Ownership in Pass Through Entities
If the entity received income (loss) from an S corporation, partnership, estate or trust, limited liability company or any other pass through enti-
ty including a qualified subchapter S subsidiary (QSSS), list below the FEIN, name and address for each entity. If additional space is need-
ed, submit a separate statement. If the income (loss) is from a QSSS, enter “yes” in the QSSS box.
FEIN
QSSS
NAME & ADDRESS
9 DIGIT - NO DASH
a
b
c
d
e
f
YES
NO
May the Department of Revenue discuss this return with the preparer shown below?
Part X. Signature and Verification
Under penalties of perjury, I declare I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct and complete. Declaration of paid preparer is based on all information of which preparer has any knowledge.
MM/DD/YY
Print/Type name of general partner, principal officer or
Signature of general partner, principal officer or
Date
Daytime phone no.
authorized individual
authorized individual
Please Sign Your Return after printing.
Paid Preparer’s Use Only
Print/Type preparer’s name
Preparer’s signature
Date
Check if
Please Sign Your Return after printing.
self-employed
Firm’s name (or yours if self-employed)
Daytime phone no.
Firms’s address
Preparer’s PTIN
9 DIGIT - NO DASH
Firm’s FEIN
9 DIGIT - NO DASH
Page 3 of 3
PRINT FORM
Reset Entire Form
RETURN TO PAGE ONE
1206210054
1206210054

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