Form Pa-8453-C - Pennsylvania Corporation Tax Declaration For A State E-File Report - 2013
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1
2PENNSYLVANIA CORPORATION TAX
2013
DECLARATION FOR A STATE e-file REPORT
Form PA-8453-C
START
Employer Identification
MMDD
MMDD
Number
For calendar year 2013 or tax year beginning
, 2013, ending
, 20___
Name of Corporation
Address
City
State
ZIP
Revenue ID Number
PART I TAX REPORT INFORMATION (Whole dollars only.)
1. Total Book Income (Form RCT-101, Section A, Line 2)
1.
2. Capital Stock/Foreign Franchise Tax (Form RCT-101, Section A, Line 18)
2.
3. Income or Loss from Federal Return on a Separate Company Basis (Form RCT-101, Section C, Line 1)
3.
4. PA Taxable Income or Loss (Form RCT-101, Section C, Line 12)
4.
5. Corporate Net Income Tax (Form RCT-101, Section C, Line 13)
5.
PART II DECLARATION OF OFFICER (See instructions.) Keep a copy of the corporation's tax report (RCT-101).
®
6a.
I consent that the corporation's refund check can be mailed directly to the address provided on the RCT-101.
®
6b.
I do not want a refund mailed to the corporation, or the corporation is not receiving a refund.
®
6c.
I authorize (1) the PA Department of Revenue and its designated financial institution to initiate an electronic funds withdrawal entry to my
financial institution account designated in the electronic portion of my 2013 Pennsylvania Corporate Tax Report for payment of my state
taxes owed; and (2) my financial institution to debit the entry to my account. I also authorize the financial institutions involved in the
processing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related
to my payment. I can revoke this authorization by notifying the PA Department of Revenue no later than two business days prior to the
payment date. I understand notification must be made by calling 717-783-6277.
If I filed a balance-due report, I understand if the PA Department of Revenue does not receive full and timely payment of my tax liability, I remain
liable for the tax due and all applicable interest and penalties. If I filed a joint federal and state tax return/report and there is an error on my federal
return, I understand my state report will be rejected.
Under penalties of perjury, I declare I am an officer of the above-named corporation and the information I provided to my electronic return originator
(ERO) and/or transmitter and the amounts in Part I above agree with the amounts on the corresponding lines of the corporation's 2013 Pennsylvania
Corporate Tax Report. To the best of my knowledge and belief, the corporation's report is true, correct and complete. I consent to my ERO and/or
transmitter sending the corporation's report and accompanying schedules and statements to the Internal Revenue Service (IRS) and subsequently by
the IRS to the PA Department of Revenue. I also consent to the PA Department of Revenue sending my ERO and/or transmitter, through the IRS, an
acknowledgment of receipt of transmission, an indication of whether or not the corporation's report is accepted and, if rejected, the reason(s) for
rejection.
MMDDYYYY
Signature of Officer
Date
Title
Social Security number
SIGN
Á
Signature of Officer – Please sign after printing
HERE
Address
City
State
ZIP
PART III DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER (See instructions.)
I declare I have reviewed the above-named corporation's report, and the entries on Form PA 8453-C are complete and correct to the best of my
knowledge. I obtained the corporate officer's signature on this form before submitting the report to the PA Department of Revenue, provided the
corporate officer a copy of all forms and information to be filed with the PA Department of Revenue and followed all other requirements specified by
the PA Department of Revenue and in IRS Pub. 3112, IRS e-file Application and Participation, and Pub. 4163, Modernized e-File (MeF) Information
for Authorized IRS e-file Providers of Forms 1120/1120S. If I am also the preparer, under penalties of perjury I declare I examined the above-named
corporation's report, accompanying schedules and statements, and to the best of my knowledge they are true, correct and complete. I understand I
am required to keep this form and the supporting documents for three years.
MMDDYYYY
ERO’s Signature
Date
Check if also
Check if
ERO’s SSN or PTIN
4
®
®
Signature of ERO – Sign after printing
paid preparer
self-employed
ERO’S
EIN
USE
FIRM NAME AND ADDRESS
4
Firm’s name (or yours
ONLY
if self-employed),
CITY
STATE
ZIP CODE
NO DASHES
address and ZIP code
Telephone Number
Under penalties of perjury, I declare I examined the above-named corporation's report, accompanying schedules and statements, and to the best of
my knowledge and belief they are true, correct and complete.
MMDDYYYY
4
Preparer’s Signature
Date
Check if
Preparer’s SSN or PTIN
®
Signature of Preparer – Please sign after printing
self-employed
PAID
PREPARER’S
4
FIRM NAME AND ADDRESS
Firm’s name (or yours
USE
if self-employed),
ONLY
CITY
STATE
ZIP CODE
NO DASHES
address and ZIP code
Telephone Number
ELECTRONIC RETURN ORIGINATORS (EROs) AND PAID PREPARERS ARE REQUIRED TO KEEP THIS FORM AND REQUIRED ATTACHMENTS FOR
THREE YEARS.
Reset Entire Form
PRINT FORM
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