Form Pa-8879-C - Pennsylvania E-File Signature Authorization For Corporate Tax Report - 2012 Page 3

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APPENDIX 2

ELECTRONIC SIGNATURE SPECIFICATIONS

Below, find the Perjury Statement, Consent to Disclosure and Electronic Funds Withdrawal Consent used to develop jurat language statements for

electronic filing tax preparation software where the practitioner federal self-select PIN method is selected. The software must provide the capability

to incorporate these elements into the appropriate text for presentation to a taxpayer for his or her review.

PERJURY STATEMENT

Under penalties of perjury, I declare I am an officer of the above-named corporation; I have examined a copy of the corporation’s 2012 electronic PA

Corporate Tax Report (RCT-101), accompanying schedules and statements; and to the best of my knowledge and belief they are true,

correct and complete.

CONSENT TO DISCLOSURE

I consent to allow my electronic return originator (ERO) or transmitter to send the corporation’s return/report to the Internal Revenue Service (IRS)

and subsequently by the IRS to the PA Department of Revenue.

ELECTRONIC FUNDS WITHDRAWAL CONSENT

I authorize 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 payment portion of my 2012 PA Corporate Tax Report for payment of my Pennsylvania taxes owed;

and 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.

OFFICER’S SIGNATURE

I am signing this tax return/report and Electronic Funds Withdrawal Consent, if applicable, by entering my federal self select PIN below.

MMDDYYYY

Officer’s PIN: _ _ _ _ _

Date: ___________

ERO DECLARATION

I declare the information in this electronic tax return/report is the information furnished to me by the corporation. If the corporation furnished me a

completed tax return/report, I declare that the information contained in this electronic tax return/report is identical to that contained in the

return/report provided by the corporation. If the furnished return/report was signed by a paid preparer, I declare I entered the paid preparer’s

identifying information in the appropriate portion of this electronic return/report. If I am the paid preparer, under the penalties of perjury, I declare I

examined this electronic return/report, and to the best of my knowledge and belief it is true, correct and complete.

ERO SIGNATURE

I am signing this tax return/report by entering my federal self select PIN below.

ERO’s PIN: _ _ _ _ _ _ and _ _ _ _ _

(EFIN)

(PIN)

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