Schedule B (Form Pa-40) - Pa Dividend Income - 2015

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1501510059
PA SCHEDULE B
Dividend Income
PA-40 Schedule B
2015
(08-15) (FI)
OFFICIAL USE ONLY
START
Name shown first on the PA-40 (if filing jointly)
Social Security Number (shown first)
CAUTION: Federal and PA rules for dividend income are different. Read the instructions.
If your total PA-taxable dividend and capital gains distributions income (taxpayer, spouse and/or joint) is equal to the amount reported
on your federal return and does not include any amounts for Lines 2 through 10 (not including subtotal Line 6) of PA Schedule B, you
must report your income on Line 3 of the PA-40, but you do not have to submit PA Schedule B. If there are any amounts (taxpayer,
spouse and/or joint) for any of the Lines 2 through 10 (not including subtotal Line 6), you must complete and submit PA Schedule B with
your PA-40. A taxpayer and spouse must complete separate schedules to report their income if any amounts are reported on Lines 2
through 10 (not including subtotal Line 6) of Schedule B. However, if all the income is earned on a joint basis, one schedule may be
completed. Complete the oval to indicate whether the income included on the schedule is from the taxpayer, spouse or joint. If a
separate PA Schedule B is prepared for a taxpayer and spouse, include only the taxpayer or spouse share of the income for each line.
PA SCHEDULE B – PA-Taxable Dividend and
Capital Gains Distributions Income
(See the instructions.)
Taxpayer
Spouse
Joint
PA-40 B (08-15)
1. $
1. Dividend income from Line 9a of your federal return. See instructions.
2. $
2. Dividend income from federal Schedule K-1(s). See instructions.
3. $
3. Pennsylvania exempt-interest dividend income. See instructions.
4. Other reduction adjustments. See instructions.
4. $
Description:
5. $
5. Add the amounts on Lines 2, 3 and 4.
6. $
6. Subtract Line 5 from Line 1.
7. Total exempt-interest dividends. See instructions.
7. $
8. Other addition adjustments. See instructions.
8. $
Description:
9. $
9. Capital Gains Distributions - See instructions.
10. Dividend income from PA S corporation(s) and partnerships, reported on your
10. $
PA Schedule(s) RK-1 or federal Schedule(s) K-1.
11. Total PA-Taxable Dividend Income. Add Lines 6, 7, 8, 9 and 10. Enter on Line 3 of your PA-40. 11. $
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1501510059
1501510059

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