PA-8453-C - 2012 PA Corporation Tax Declaration for a State E-File Report
Preparer’s Signature Date Check if Preparer’s SSN or PTIN
self-employed
®
Telephone Number
SIGN
HERE
ERO’s Signature Date Check if also Check if ERO’s SSN or PTIN
paid preparer
®
self-employed
®
EIN
Telephone Number
Signature of Officer Date Title Social Security Number
Address City State ZIP
Á
ERO’S
USE
ONLY
Form PA-8453-C
2012
PENNSYLVANIA CORPORATION TAX
DECLARATION FOR A STATE e-file REPORT
For calendar year 2012 or tax year beginning , 2012, ending , 20___
Employer Identification
Number
Name of Corporation
Address City State ZIP Revenue ID Number
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.
Firm’s name (or yours
if self-employed),
address and ZIP code
PAID
PREPARER’S
USE
ONLY
Firm’s name (or yours
if self-employed),
address and ZIP code
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 2012 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 2012 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.
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.
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.
4
4
4
4
PART I TAX REPORT INFORMATION (Whole dollars only.)
PART II DECLARATION OF OFFICER (See instructions.) Keep a copy of the corporation's tax report (RCT-101).
PART III DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER (See instructions.)
ELECTRONIC RETURN ORIGINATORS (EROs) AND PAID PREPARERS ARE REQUIRED TO KEEP THIS FORM AND REQUIRED ATTACHMENTS FOR
THREE YEARS.
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