Form Pa-8879-C - Pennsylvania E-File Signature Authorization For Corporate Tax Report - 2012

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PENNSYLVANIA e-file SIGNATURE AUTHORIZATION
FOR CORPORATE TAX REPORT RCT-101
Form PA-8879-C
START
See instructions.
MMDD
MMDD
2012
For calendar year 2012 or tax year beginning
, 2012, ending
, 20___.
Name of Corporation
Employer Identification Number
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 AND SIGNATURE AUTHORIZATION OF OFFICER (Keep a copy of the corporation's tax report.)
Under penalties of perjury, I declare I am an officer of the above-named corporation and I examined a copy of the corporation's 2012 electronic
tax report, accompanying schedules and statements, and to the best of my knowledge and belief they are true, correct and complete. I further
declare the amounts in Part I above are the amounts shown on the copy of the corporation's electronic tax report. I consent to allow my
electronic return originator (ERO) and/or transmitter to send the corporation's report to the PA Department of Revenue and receive from the
PA Department of Revenue an acknowledgement of receipt or reason for rejection of the transmission. If applicable, I authorize the PA Department
of Revenue and its designated financial institution to initiate an electronic funds withdrawal entry to the financial institution account indicated in
the tax preparation software for payment of the corporation's state taxes owed on this report, and I authorize the financial institution to debit the
entry to this account. To revoke a payment, I must contact the PA Department of Revenue no later than two business days prior to the payment
date by calling 717-783-6277. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive
confidential information necessary to answer inquiries and resolve issues related to the payment. I selected a federal self-select PIN as my
signature for the corporation's electronic tax report and, if applicable, the corporation's consent to electronic funds withdrawal.
Officer’s Federal Self-Select PIN (check one box only):
®
_______________
I authorize ________________________________________________ to enter my federal self-select PIN
as my signature
ERO firm name
Do not enter all zeros.
on the corporation’s electronically filed tax report.
®
As an officer of the corporation, I will enter my federal self-select PIN as my signature on the corporation’s electronically filed tax report.
MMDDYYYY
Officer’s Signature
Date
Title
Social Security number
Signature of Officer – Please sign after printing
Address
City
State
ZIP
PART III CERTIFICATION AND AUTHENTICATION
ERO’s EFIN/PIN (Enter your six-digit EFIN followed by your five-digit federal self-select PIN.):
Do not enter all zeros.
As a participant in the Practitioner PIN Program, I certify the above numeric entry is my federal self-select PIN, which is my signature on the tax year
2012 electronically filed corporate tax report for the taxpayer(s) indicated above. I confirm I am participating in the Practitioner PIN Program in accor-
dance with the requirements established for this program.
MMDDYYYY
Signature of ERO – Sign after printing
ERO’s Signature 4
Date 4
ERO must retain this form and the supporting documents for three years.
DO NOT SUBMIT THIS FORM TO THE PA DEPARTMENT OF REVENUE UNLESS REQUESTED TO DO SO.
Reset Entire Form
PRINT FORM

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