page 1 of 3 (05-10) (fi 2010 - pstap

2 Net Business Income (Loss) . . . . . . . . . . . . . . . . . 2a �00 2e �002 Share of Business Income (Loss) from

Other Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b �00 2f �002 Previously Disallowed PA Source CNI

Deductions - PA S Corporations only . . . . . . . . . 2c �00 2g �002 Calculate Adjusted/Apportioned Net Business

Income (Loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d �00 2h �00

Part II. Apportioned/Allocated PA-Taxable Business Income (Loss)

Part III. Allocated Other PA PIT Income (Loss)

3 Interest Income from PA Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3h �004 Dividend Income from PA Schedule B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4h �005 Net Gain (Loss) from PA Schedule D . . . . . . . . . . . . . 5a �00 5b �006 Rent/Royalty Net Income (Loss) from

PA Schedule M, Part B . . . . . . . . . . . . . . . . . . . . . . . . 6a �00 6b �007 Estates or Trusts Income from PA Schedule J . . . . . . 7a �00 7b �008 Gambling and Lottery Winnings from PA Schedule T . . 8a �00 8b �009 Total Other PA PIT Income (Loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b �00

Part I. Total Taxable Business Income (Loss) from Operations Everywhere1a Taxable Business Income (Loss) from Operations Everywhere . . . . . . . . . . . . . . . . . . . . . . . . . 1a �001b Share of Business Income (Loss) from All Other Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b �001c Total Income (Loss). Add Line 1a and Line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c �001d Previously Disallowed CNI Deductions - PA S Corporations only . . . . . . . . . . . . . . . . . . . . . 1d �001e Total Adjusted Business Income (Loss). Subtract Line 1d from Line 1c . . . . . . . . . . . . . . . . . . . . . . 1e �00

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1006010050

10060100501006010050

EC FCOFFICIAL USE ONLY

PLEASE PRINT. USE BLACK INK.

Filing Status:PA-20S PA-65 PA-KOZ PS

USE BLACK INKSUBMIT ALL SUPPORTING SCHEDULES

FEIN

CBusiness Name

First Line of Address - Street Address - If Address has Apartment Number, Suite, RR No. - Place on this Line.

Second Line of Address - PO Box

City or Post Office State ZIP Code

PA ACCOUNT # NAICS CodeNAICS Code Changefrom Previous Year

PA-20S/PA-65PA S Corporation/PartnershipInformation ReturnPAGE 1 of 3 (05-10) (FI) 2010

If a loss, fill in the oval next to the line

of 3

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PA SourceOutside PA

PA SourceOutside PA

Method of Accounting

Accrual

Cash

Other, Describe

Extension Requested

Initial Year

Fiscal YearBeginning Ending_________ _________

Final Return

FEIN/Name/AddressChange

Amended InformationReturnShort-Year Return

Date activity began in PA____________________________

(MMDDYYYY)

Fill in the applicable ovals

Part IV. Total PA S Corporation or Partnership Income (Loss)

10 Total Income (Loss) per Books and Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 �0011 Total Reportable Income (Loss). Add Lines 1e and 9 or Add Lines 2h and 9 . . . . . . . . . . . . . . . . . 11 �0012 Total Nontaxable/Nonreportable Income (Loss). Subtract Line 11 from Line 10 . . . . . . . . . . . 12 �00

Part V. Pass Through Credits - See the PA-20S/PA-65 instructions

13a Total Other Credits. Submit PA-20S/PA-65 Schedule OC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a �0013b Resident Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b �0014a PA 2010 Quarterly Tax Withholding/Extension Payments for Nonresident Owners . . . . . . . . . . . . . 14a �0014b Final Payment of Nonresident Withholding Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b �0014c Total PA Income Tax Withheld. Add Lines 14a and 14b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c �00

Part VI. Distributions - See the PA-20S/PA-65 instructions – Partnerships Only

15 Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 �0016 Guaranteed Payments for Capital or Other Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 �00

17 All Other Guaranteed Payments for Services Rendered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 �00

18 Guaranteed Payments to Retired Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 �00

Distributions - See the PA-20S/PA-65 instructions – PA S Corporations Only

19 Distributions from PA Accumulated Adjustments Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 �0020 Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 �00

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1006110058

1006110058 1006110058

FEIN

CBusiness Name

of 3

Part VII. Other Information – See the PA-20S/PA-65 instructions for each line

01 During the entity’s tax year, did the entity own any interest in another partnership or in any foreign entity that wasdisregarded as an entity separate from its owner under federal regulations Sections 301.7701-2 and 301.7701-3?If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

02 Does the entity have any tax-exempt partners/members/shareholders? If yes, submit statement . . . . . . . . . . . . . . . . 2

03 Does the entity have any foreign partners/members/shareholders (outside the U.S.)? If yes, submit statement . . . . . 3

04 Was there a distribution of property or a transfer (e.g., by sale or death) of a partner/member interest during thetax year? (Partnership only) If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

05 Has the federal government changed taxable income as originally reported for any prior period? If yes, indicateperiod on supplemental statement, and submit final IRS determination paperwork . . . . . . . . . . . . . . . . . . . . . . . . . . 5

06 Does the entity have any foreign operations or ownership in a foreign bank account? If yes, submit statement . . . . 6

07 Is this entity involved in a reportable transaction, listed transaction, or registered tax shelter within this return?If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

08 Does the entity have any corporate partners? Provide the PA Account # for each corporate partner listed on thePartner/Member/Shareholder Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

09 Has the entity sold any tax credits? If yes, submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Has the entity changed its method of accounting for federal income tax purposes during this tax year? If yes, submit federal Form 3115 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Has the entity entered into any like-kind exchanges under IRC Section 1031? If yes, submit federal Form 8824 . . 11

12 PA Apportionment as reported on PA-20S/PA-65 Schedule H-Corp . . . . . . . . . . . . . . . . . . . . . . . . . 12

Yes or No

�

PA-20S/PA-65PAGE 2 of 3 (05-10) (FI) 2010

1 Balance at the beginning of the taxable year . . . . If AAA is negative, fill in the oval 1

2 Total reportable income from Part IV, Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Other additions. Submit an itemized statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Loss from Part IV, Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Other reductions. Submit an itemized statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Sum of Lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Balance at taxable year-end. Subtract Line 7 from Line 6 . . . . . . . . . . . . . . . . . . . . . . . 8

1006210056

10062100561006210056

Part VIII. PA S Corporations Only - Accumulated Adjustments Account (AAA)and Accumulated Earnings and Profits (AE&P)

Part IX. Ownership in Pass Through EntitiesIf the entity received income (loss) from an S corporation, partnership, estate or trust, limited liability company or any other pass through enti-ty including a qualified subchapter S subsidiary (QSSS), list below the FEIN, name and address for each entity. If additional space is need-ed, submit a separate statement. If the income (loss) is from a QSSS, enter “yes” in the QSSS box.

FEIN

CBusiness Name

PA-20S/PA-65PAGE 3 of 3 (05-10) (FI) 2010

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Part X. Signature and Verification

Signature of General Partner, Principal Officer, or Authorized Individual Date Daytime Telephone Number

Paid Preparer’s Use OnlyPreparer’s signature Date Check if

self-employed

Firm’s name (or yours Daytime Telephone Numberif self-employed),address, and ZIP code

Under penalties of perjury, I declare I have examined this return, including accompanying schedules and statements, and to the best of my knowledge andbelief, it is true, correct and complete. Declaration of paid preparer is based on all information of which preparer has any knowledge.

Preparer’s SSN or Preparer’s PTIN Firm’s FEIN

May the Department of Revenue discuss this return with the preparer shown below? YES NO

a

b

c

d

e

f

QSSS NAME & ADDRESSFEIN

AAA AE&P

N/A

N/A

PA SCHEDULE AInterest IncomePA-20S/PA-65 A (05-10) (FI)

1008610055

1008610055 1008610055

2010OFFICIAL USE ONLY

Name as shown on PA-20S/PA-65 Information Return FEIN

See the PA-20S/PA-65 Schedule A instructions and the PA PIT Guide on the department’s website.

1. Interest income from federal Schedule K 1.

2. Less business or rental interest income (working capital) - report on PA-20S/PA-65 Schedule M, Part A 2.

3. Adjusted federal interest income – subtract Line 2 from Line 1 3.

4. Federal-exempt interest income taxable for PA PIT – itemize below 4.

5. Other interest income not included on Line 3 and Line 4 5.

6. Gross PA interest income – add Lines 3 through 5 6.

7. PA-exempt interest income included on Line 6 – itemize below 7.

PA-taxable interest income – subtract Line 7 from Line 6. Enter the result on the PA-20S/PA-658. Information Return, Page 1, Part III, Line 3. 8.

Federal-exempt interest income – list sources and amounts

PA-exempt interest income – list sources and amounts

1008710053

1008710053 1008710053

2010

PA SCHEDULE BDividend and Capital Gains Distributions IncomePA-20S/PA-65 B (05-10) (FI)

OFFICIAL USE ONLY


See the PA-20S/PA-65 Schedule B instructions and the PA PIT Guide on the department’s website.

1. Ordinary dividend income from federal Schedule K 1.

2. Less business or rental dividend income (working capital) - report on PA-20S/PA-65 Schedule M, Part A 2.

3. Adjusted federal dividend income – subtract Line 2 from Line 1 3.

4. Federal-exempt dividend income taxable for PA PIT – itemize below 4.

5. Other dividend income not included on Line 3 and Line 4 5.

6. Capital gains distributions income 6.

7. Gross PA-taxable dividend income – add Lines 3 through 6 7.

8. PA-exempt dividend income on Line 7 – itemize below 8.

PA-taxable dividend income and capital gains distributions income – subtract Line 8 from Line 7.9. Enter the result on the PA-20S/PA-65 Information Return, Page 1, Part III, Line 4. 9.

Federal-exempt dividend income – list sources and amounts

PA-exempt dividend income – list sources and amounts

2010

PA SCHEDULE D-ISale, Exchange or Disposition of PropertyWithin PennsylvaniaPA-20S/PA-65 D (05-10) (FI)

1006410052

1006410052 1006410052

2. All PA-source gain (loss) included in ordinary net rental/royalty income (loss)from federal Form 8825 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. All PA-source net short-term capital gain (loss) from federal Schedule D . . . . . . . . . . . . . . .

4. All PA-source net long-term capital gain (loss) from federal Schedule D . . . . . . . . . . . . . . . .

5. All other PA-source net IRC Section 1231 gain (loss) reported on federal Form 4797not listed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. All PA-source gain (loss) from the disposition of IRC Section 179 property . . . . . . . . . . . . . .

7. Capital gains distributions taxed as dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. PA-source gain (loss) on federal non-taxable exchanges on IRC Sections 1031 and 1033 . . . . .

10. Total PA-source federal gain (loss) reportable for PA PIT before additional classificationand/or adjustments. Add Lines 8 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. PA-source adjustment for gain (loss) reflected on Part A of Schedule M for business income(loss) (net profits from a business, profession, or farm) . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2.

3.

4.

5.

6.

7.

9.

10.

11.

OFFICIAL USE ONLY

Federal Realized and Recognized Gains (Losses):

C

Name as shown on the PA-20S/PA-65 Information Return FEIN

12. PA-source PIT reportable Schedule D gain (loss) before PA PIT adjustments(Line 10 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

13. Net or aggregate PA-source PIT adjustments for Schedule D gain (loss) from transactionsrequiring adjustment for PA/Fed gain (loss) differences. Itemize on Schedule D-II . . . . . . . . . 13.

14. Net adjustment to arrive at PA-source PIT Schedule D reportable gain (loss). Add Lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

15. PA-source partnership and PA S corp gain (loss) from PA Schedules RK-1 and NRK-1 . . . . . .15.

16. Total PA-source Schedule D net gain (loss) from property within PA for residents only. AddLines 14 and 15. Enter this number on Page 1, Part III, Line 5b of the PA-20S/PA-65 . . . . . . 16.

17. PA-source adjustment for gain (loss) on sale of short-term portfolio investmentsnot used in working capital for nonresidents only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.

18. Total PA-source Schedule D net gain (loss) from property within PA for nonresidents only. (Line 16minus Line 17). This line should be allocated to the NRK-1s based on percentage interest . . . 18.

1. All PA-source gain (loss) included in ordinary business income (loss) . . . . . . . . . . . . . . . . .

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8. Total PA-source federal realized and recognized reportable gain (loss) before classificationand/or adjustment amounts for PA PIT purposes. Add Lines 1 through 6, minus Line 7 . . . . . . . . . . 8.

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(If a loss,fill in oval)

Amended Schedule If Part I is blank, fill in the oval

Part I. Allocated gain (loss) from the Sale, Exchange or Disposition of Property within Pennsylvania. Enter whole dollars only.

1. Type of Property Description of Property:





Part II. Sale, Exchange or Disposition of Property within Pennsylvania. If any of the federal gain (loss) transactions require adjustment, list eachtransaction and show the differences in federal gain (loss). The difference in PA/federal gain (loss) equals PA gain (loss) minus federal gain (loss). If the difference isnegative, fill in the loss oval. Copy PA-20S/PA-65 Schedule D-II to list additional properties. Enter whole dollars only.Type of Property: R=Real P=Personal S=Security O=Other Intangible (not security)

2010

PA SCHEDULE D-IISale, Exchange or Disposition of PropertyWithin PennsylvaniaPA-20S/PA-65 D (05-10) (FI)

1006510059

1006510059 1006510059

OFFICIAL USE ONLY

Cost or other PA basisPA allowed or allowable depreciationDate acquired

Difference in PA/Fed Gain (Loss)Gross sales priceDate sold

Date acquired

Date sold

Date acquired

Date sold

Date acquired

Date sold

Date acquired

Date sold

Page 2 of 4

C


Cost or other PA basisPA allowed or allowable depreciation

Difference in PA/Fed Gain (Loss)Gross sales price







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Amended Schedule If Part II is blank, fill in the oval

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

2010

PA SCHEDULE D-IIISale, Exchange or Disposition of PropertyOutside PennsylvaniaPA-20S/PA-65 D (05-10) (FI)

1006610057

1006610057 1006610057

OFFICIAL USE ONLY

C


2. All outside PA gain (loss) included in ordinary net rental/royalty income (loss)from federal Form 8825 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. All outside PA net short-term capital gain (loss) from federal Schedule D . . . . . . . . . . . . . . .

4. All outside PA net long-term capital gain (loss) from federal Schedule D . . . . . . . . . . . . . . .

5. All other outside PA net IRC Section 1231 gain (loss) reported on federal Form 4797not listed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. All outside PA gain (loss) from the disposition of IRC Section 179 property . . . . . . . . . . . . . .

7. Capital gains distributions taxed as dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Outside PA gain (loss) on federal non-taxable exchanges on IRC Sections 1031 and 1033 . . . .

10. Total outside PA federal gain (loss) reportable for PA PIT before additional classificationand/or adjustments. Add Lines 8 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Outside PA adjustment for gain (loss) reflected on Part A of Schedule M for business income(loss) (net profits from a business, profession, or farm) . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2.

3.

4.

5.

6.

7.

9.

10.

11.

Federal Realized and Recognized Gains (Losses):

12. Outside PA PIT reportable Schedule D gain (loss) before PA PIT adjustments(Line 10 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

13. Net or aggregate outside PA PIT adjustments for Schedule D gain (loss) from transactionsrequiring adjustment for PA/Fed gain (loss) differences. Itemize on Schedule D-IV . . . . . . . . . 13.

14. Net adjustment to arrive at outside PA PIT Schedule D reportable gain (loss). AddLines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

15. Outside partnership and PA S corp gain (loss) from PA Schedules RK-1 and NRK-1 . . . . . . . 15.

16. Total outside PA Schedule D net gain (loss) from property outside PA. Add Lines 14 and 15.Enter this number on Page 1, Part III, Line 5a of the PA-20S/PA-65 Information Return . . . . . 16.

1. All outside PA gain (loss) included in ordinary business income (loss) . . . . . . . . . . . . . . . .

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8. Total federal realized and recognized outside PA-source reportable gain (loss) beforeclassification and/or adjustment amounts for PA PIT purposes. Add Lines 1 through 6, minus Line 7. 8.

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(If a loss,fill in oval)

Amended Schedule If Part III is blank, fill in the oval

Part III. Allocated gain (loss) from the Sale, Exchange or Disposition of Property outside Pennsylvania. Enter whole dollars only.

1006710055

1006710055 1006710055

2010

PA SCHEDULE D-IVSale, Exchange or Disposition of PropertyOutside PennsylvaniaPA-20S/PA-65 D (05-10) (FI

OFFICIAL USE ONLY






Date acquired

Date sold

Date acquired

Date sold

Date acquired

Date sold

Date acquired

Date sold

Date acquired

Date sold

Page 4 of 4

C












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Amended Schedule If Part IV is blank, fill in the oval

Part IV. Sale, Exchange or Disposition of Property outside Pennsylvania. If any of the federal gain (loss) transactions require adjustment, listeach transaction and show the differences in federal gain (loss). The difference in PA/federal gain (loss) equals PA gain (loss) minus federal gain (loss). If the difference isnegative, fill in the loss oval. Copy PA-20S/PA-65 Schedule D-IV to list additional properties. Enter whole dollars only.Type of Property: R=Real P=Personal S=Security O=Other Intangible (not security)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

(MMDDYYYY)

PA SCHEDULE MReconciliation of Federal-Taxable Income (Loss) to PA-TaxableIncome (Loss)PA-20S/PA-65 M (05-10) (FI)

Name as shown on PA-20S/PA-65 Information Return FEIN PA Sales Tax License Number

PA Schedule M, Part A. Classifying Federal Income (Loss) for PA Personal Income Tax PurposesClassify, without adjustment, the federal income (loss) from Schedule K of federal Form 1120S or from Schedule K of federal Form 1065. The entity must allocate or apportionthe amounts from the federal categories to the reportable PA PIT classes. The total of the specific federal line items should equal the total of the federal schedule.

Federal Form Classified for Pennsylvania Personal Income Tax purposes

Form 1120S, Schedule K line (a) (b) (c) (d) (e) (f)

description Federal PA Business Interest Dividend Gain (loss) Rent & Royalty

Form 1065, Schedule K line Income Income Income Income From Sales Income (loss)

description (loss) (loss) PA Schedule A PA Schedule B PA Schedule D PA Schedule E

1. Ordinary income (loss) from

trade or business activities

2. Net income (loss) from rental

real estate activities

3. Other gross rental income (loss)

4. Interest income

5. Dividends

6. Royalty income

7. Net short-term capital gain (loss)

8. Net long-term capital gain (loss)

9. Net gain (loss) from disposal of

IRC Section 179 property

10. Net IRC Section 1231 gain (loss)

from Form 4797

11. Other income (loss)

12. Total PA income (loss) by

classification. Total the amounts

in each column.

2010

1007010059

10070100591007010059

OFFICIAL USE ONLY

PA SCHEDULE MReconciliation of Federal-Taxable Income (Loss) to PA-TaxableIncome (Loss)PA-20S/PA-65 M (05-10) (FI)


PA Schedule M, Part B. Determining PA Reportable Income (Loss) by ClassificationThe entity may need to prepare a PA Schedule M, Part B, if it must make adjustments to properlydetermine its reportable classified income (loss) for its PA-20S/PA-65 Information Return. This specificlist of adjustments applies to income (loss) from a business or farm, and rental/royalty income (loss).Enter whole dollars only.

Section A. Federal Classified Income (Loss). Income class from Part A, Column:Enter the initial of Column (b) or (f) only.

Section B. Itemize income adjustments that increase PA reportable income (reduce the loss).

a. Deferred income relating to advance payments for goods and services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Difference in gain (loss) for each business sale of property where the proceeds were reinvested in the sameline of business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Gain from business like-kind exchanges, see PA PIT Guide for instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d. Gain (loss) on involuntary conversions – IRC Section 1033 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Income from cancellation of debt that PA treats differently from federal rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Increases in income in the year of change resulting from spread in the year of change associated with IRCSection 481(a) adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. Income from obligations of other states and organizations that is not exempt for PA purposes . . . . . . . . . . . . . . . .

h. Other taxable income for PA purposes the entity does not report for federal purposes. Submit statement . . . . . . .

B. Total

Section C. Itemize income adjustments that decrease the PA reportable income (increase the loss).

a. Difference in gain (loss) for each business sale when proceeds were reinvested in the same line of business . . . .

b. Income from obligations of the U.S. government and other organizations that is not taxable for PA purposes . . . . .

c. Decreases for previously reported income in prior year resulting from spread associated with IRC Section 481(a).

d. Other PA nontaxable income the entity reported for federal purposes. Submit statement . . . . . . . . . . . . . . . . . . . .

C. Total

Section D. Adjusted PA Reportable Income. See PA-20S/PA-65 Schedule M instructions.

Section E. Itemize those expenses that PA law does not allow that the entity deducted on its federal form.These adjustments increase PA reportable income (reduce the loss).

a. Taxes paid on income from the worksheet in the PA PIT Guide. Submit worksheet . . . . . . . . . . . . . . . . . . . . . . . . .

b. Differences in depreciation taken for PA and federal purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Key man life insurance premiums (owners as beneficiaries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d. Differences in PA treatment of guaranteed payments for capital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Differences in depreciation for bonus depreciation (PA law does not allow bonus depreciation.) . . . . . . . . . . . . . . .

f. Expense adjustments to qualify for the PA credits claimed in Part V of the PA-20S/PA-65 . . . . . . . . . . . . . . . . . . . .

g. Other expenses the entity deducted on its federal return that PA does not allow. Submit statement . . . . . . . . . . . .

E. Total

Section F. Itemize those expenses that PA law allows that the entity could not deduct on its federal form.These adjustments decrease PA reportable income (increase the loss).

a. 50 percent of business meals, entertainment, and club dues that the entity could not deduct . . . . . . . . . . . . . . . . .

b. Sales tax on depreciable assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Differences in depreciation taken for PA and federal purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d. IRC Section 179 expenses (the maximum for PA purposes is $25,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Expenses for employees, including PA S corporation shareholder-employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Life insurance premiums (PA S corporation or partnership as beneficiary) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. Expense adjustments to qualify for federal credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h. Other expenses PA allows that the entity did not deduct on the federal return. Submit statement . . . . . . . . . . . . . .

i. Use Tax claimed and remitted - not previously capitalized. Include a copy of the PA-1 form . . . . . . . . . . . . . . . . . .

F. Total

Section G. Total Taxable Income (Loss). Add Section D, plus E, minus F.

1007110057

2.1.

18.17.

10.

2.

16.

2.

2.

4.

6.

8.

10.

2.

4.

6.

8.

2.

4.

6.

8.

10.

12.

14.

9.

1.

15.

1.

3.

5.

7.

1.

3.

5.

7.

9.

11.

13.

2.

4.

6.

8.

10.

12.

14.

16.

18.

20.

1.

1.

3.

5.

7.

9.

11.

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17.

19.

12.

14.

16.

1.

3.

5.

7.

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13.

15.

OFFICIAL USE ONLY

PA AllocatedIncome (Loss)

Total Rental Income (Loss) orTotal Business Income (Loss)

Before Apportionment

2010

Part B. (Enter amounts in whole dollars) Property A Property B Property C Property D

Income (As reported on federal Form 8825)

1. Rental income received . . . . . . . . . . . . . . 1.

2. Royalty income received . . . . . . . . . . . . . 2.

Expenses (As reported on federal Form 8825)

3. Automobile and travel . . . . . . . . . . . . . . . 3.

4. Commissions . . . . . . . . . . . . . . . . . . . . . 4.

5. Legal and professional fees . . . . . . . . . . . 5.

6. Repairs . . . . . . . . . . . . . . . . . . . . . . . . . 6.

7. Management fees . . . . . . . . . . . . . . . . . . 7.

8. Advertising . . . . . . . . . . . . . . . . . . . . . . 8.

9. Cleaning and maintenance . . . . . . . . . . . 9.

10. Insurance . . . . . . . . . . . . . . . . . . . . . . .10.

11. Interest . . . . . . . . . . . . . . . . . . . . . . . . .11.

12. Taxes (not based on net income) . . . . . . .12.

13. Utilities . . . . . . . . . . . . . . . . . . . . . . . . .13.

14. Wages and salaries . . . . . . . . . . . . . . . .14.

15. Depreciation expense . . . . . . . . . . . . . . .15.

Important. PA PIT law does not permit any federal bonus depreciation and limits IRC Section 179 expensing. See the PA PIT Guide.

16. Other expenses (itemize): . . . . . . . . . . . .16.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. Total Expenses for Each Property – Add Lines 3 through 16. . . . . . . . . . . . . .17.

Income or Loss:

18. Income – If Line 1 or 2 is greater thanLine 17. . . . . . . . . . . . . . . . . . . . . . . . . . . .18.

19. Loss – If Line 1 or 2 is less than Line 17.(fill in the oval). . . . . . . . . . . . . . . . . . . .19.

20. Income (loss) from property within Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(If loss, fill in oval) 20.

21. Income (loss) from property outside Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(If loss, fill in oval) 21.

22. Rent or royalty income (loss) from PA sources from PA Schedule(s) NRK-1. . . . . . . . . . . . . . . . . . . . . .(If loss, fill in oval) 22.

23. Rent or royalty income (loss) from sources outside PA from PA Schedule(s) RK-1 and NRK-1. . . . . . . . . .(If loss, fill in oval) 23.

24. Net rent and royalty income (loss) from PA sources. Add Lines 20 and 22. . . . . . . . . . . . . . . . . . . . . .(If loss, fill in oval) 24.

25. Net rent and royalty income (loss) from outside Pennsylvania. Add Lines 21 and 23. . . . . . . . . . . . . . . . .(If loss, fill in oval) 25.

Note: Net gain (loss) from federal Form 4797, from the disposition of property from rental real estate activities must be reported on

PA-20S/PA-65 Schedule D.

Note: The sum of Lines 24 and 25 should generally agree to PA-20S/PA-65 Schedule M, Part A, Lines 2, 3 and 6, Column (f).

Part A. Property Description Enter the address and type of each rental property and/or each source of royalty income. If the property is outside PA, fill in the oval.

A

B

C

D

PA SCHEDULE ERent and Royalty Income (Loss)PA-20S/PA-65 E (05-10) (FI) 2010

1006810053

1006810053 1006810053

OFFICIAL USE ONLY


LOSS

LOSS

LOSS

LOSS

LOSS

LOSS

Copy PA-20S/PA-65 Schedule E to list additional properties.

��

��

PA SCHEDULE CPCorporate Partner WithholdingPA-20S/PA-65 CP (05-10) (FI) 2010

1008210054

10082100541008210054

Part I General Information for Corporate Partner

Name of Corporation Corporate Partner FEIN

First Line of Address

Second Line of Address

City or Post Office State ZIP Code Enter the date the corporationbecame a partner (MMDDYYYY)

Part II General Information for the Partnership that withholds and remits Corporate Net Income Tax for Nonfiling Corporate Partners

Name of Partnership issuing this form Partnership FEIN

Address

City or Post Office State ZIP Code Enter the date the partnership begandoing business in PA (MMDDYYYY)

Part III Income for Corporate Partner from Federal Schedule K-1 If a loss, enter “0”.

1. Ordinary income from trade or business activities $

2. Net income from rental real estate activities $

3. Net income from other rental activities $

4. Guaranteed payments $

5. Interest income $

6. Ordinary dividends $

7. Royalties $

8. Net short-term capital gain $

9. Net long-term capital gain $

10. Net IRC Section 1231 gain $

11. Net gain from disposal of IRC Section 179 property $

12. Other income $

13. Total Lines 1 through 12 $

14. Apportionment from PA-20S/PA-65 Schedule H-Corp

15. Income apportioned to Pennsylvania (Multiply Line 13 by Line 14.) $

16. Corporate net income tax withholding (Multiply Line 15 by 0.0999) $

Note to Corporate Partner: The amount on Line 16 has been remitted by the issuing partnership on the corporation’s behalf in payment of

PA corporate net income tax. The partnership was not permitted to adjust the federal Schedule K-1 income for expenses or deductions. To claim

expenses or deductions or to offset between classes of income, the corporation should file an RCT-101, PA Corporate Tax Report, and

if appropriate, file for a refund.

Note to Partnership preparing Schedule CP: The partnership must complete this schedule to determine the withholding for nonfiling corporate

partners required to file an RCT-101, PA Corporate Tax Report. Before completing this schedule, complete the PA-20S/PA-65 Schedule H-Corp

(to apportion business income (loss) for the corporate partner). The partnership should use the federal Schedule K-1 to calculate withholding

for any corporate partner that it is not filing an RCT-101. Withholding is based on federal Schedule K-1 income only, without regard to losses or

deductions.

Corporate Partner’s percentage of:

Profit sharing %

Loss sharing %

Ownership of capital %

�

�

1. Real and Tangible Property. Enter the amount from Line 1C.

2. Wages, Salaries, Commissions, and Other Compensation. Enter the amount from Line 2C.

3. Sales. Enter the amount from Line 3C.

4. Total Lines 1 through 3.

5. Apportionment - Divide Line 4 by 3, if all three factors apply; by 2, if only two factors apply; or by 1, if only one factor applies. Calculate to six decimal places.

6. Total Net Income (Loss) from business. From Schedule M, Part B, Section G, Line 2

7. Net Income (Loss) for Pennsylvania. Multiply Line 6 by Line 5.Enter on the PA-20S/PA-65 Information Return, Part II, Line 2e.

Real and Tangible Property Owned (original cost value)

Land and Buildings, including property rented * . . . . . . .

Machinery and Equipment, including property rented * .

Furniture and Fixtures, including property rented * . . . .

Automobiles and Trucks, including property rented * . . .

Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Tangible Property, including property rented * . . .

Total Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. (A) 1. (B)

* Eight times net annual rental rate (Attach Schedule)

1C. Property factor (divide 1(B) by 1(A) - calculate to six decimal places) �

�

Sales (Net of Returns and Allowances) . . . . . . . . . . . . . . . .

Interest, Dividends, Rents, Royalties . . . . . . . . . . . . . . . . . .

Other Income (receipts only) . . . . . . . . . . . . . . . . . . . . . . . . .

Gross Sales Price of Assets (except securities**) . . . . . . . .

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. (A) 3. (B)

** Unless you are a securities dealer

3C. Sales factor (divide 3(B) by 3(A) - calculate to six decimal places) �

PA SCHEDULE HApportioned Business Income(Loss)/Calculation of PA NetBusiness Income (Loss)PA-20S/PA-65 H (05-10) (FI) 2010

1006910051

1006910051 1006910051

OFFICIAL USE ONLY

�

�

�

Total Everywhere

Total Everywhere

Total Everywhere

Within Pennsylvania

Within Pennsylvania

Within Pennsylvania

TABLE 1 - PROPERTY FACTOR Description

TABLE 2 - PAYROLL FACTOR Description

TABLE 3 - SALES FACTOR Description

Wages, salaries, commissions and other compensationto employees in:

Cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Compensation of officers . . . . . . . . . . . . . . . . . . . . . . . . .

Salesmen’s salaries and commissions . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total Payroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. (A) 2. (B)

2C. Payroll factor (divide 2(B) by 2(A) - calculate to six decimal places) �

APPORTIONED INCOME (LOSS) FROM A BUSINESS, PROFESSION, OR FARM DERIVED FROM SOURCES BOTH WITHINAND OUTSIDE PENNSYLVANIA.Complete this schedule and submit it with the PA-20S/PA-65 Information Return if a PA S corporation, partnership or limited liability company filing asa partnership or PA S corporation for federal income tax purposes derives business income from sources within and outside Pennsylvania or is locatedin a KOZ. If one or more of the partners is a C corporation, the partnership must also complete PA-20S/PA-65 Schedule H-Corp and submit a copy toeach corporate partner. DO NOT USE THIS SCHEDULE TO APPORTION PA-SOURCE INCOME FROM OTHER ENTITIES.

The entity must calculate a figure as required in 1C, 2C and 3C to apply to net business income (loss) to determine the amount from withinPennsylvania. Line 5 is an average of the sum of three fractions shown below.

NET BUSINESS INCOME (LOSS) APPORTIONMENT FORMULASubmit a statement listing all places BOTH WITHIN AND OUTSIDE PENNSYLVANIA where the entity operates its business.


Special Apportionment to be completed only by railroad, truck, bus, and airline entities, pipeline or natural gas entities and water transportationentities. (Refer to PA-20S/PA-65 Schedule H instructions) (A)

(B)= �

(A) Numerator

(B) Denominator

Name of Corporate Partner

Street Address City State ZIP Code

C

FEIN PA Account # Nonfiling Corporation CNI Tax Withholding



cForeign Entity

Name of General Partner or Authorized Individual Date Daytime Telephone Number


Preparer’s Signature

Preparer’s Name Date Daytime Telephone Number

Submit a complete federal Form 1065 for the entity above and Schedule K-1 for each corporate partner listed below.

Copy the PA-65 Corp to list additional corporate partners. Enter whole dollars only. Amended PA-65 Corp

1. List each corporate partner:

PA-65 CorpDirectory ofCorporate PartnersPA-65 Corp (05-10) (FI) 2010

1008110056

10081100561008110056

OFFICIAL USE ONLYPLEASE PRINT. USE BLACK INK.

C

Partnership FEIN

C

FEIN PA Account #

Partnership Business Name

ZIP CodeStateCity or Post Office



Nonfiling Corporation CNI Tax Withholding



4. Total corporate net income tax withholding forall nonfiling corporate partners for this entity.

a

2. Total number of corporate partners for this entity.

3. Total number of corporate partners registered in PA for this entity.

Foreign Entity

C

FEIN PA Account # Nonfiling Corporation CNI Tax Withholding

bForeign Entity

5. PA Apportionment as reported on PA-20S/PA-65 Schedule H-Corp. �

PA Apportionment. Add the amounts on Lines 1C,

2C, and 3C and divide by 100 if all three proportions apply. �

Wages, salaries, commissions and other compensation

to employees in:

Cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Compensation of officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Salesmen’s salaries and commissions . . . . . . . . . . . . . . . . . . . . .

Other payroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partner’s share of payroll from partnerships . . . . . . . . . . . . . . . .

Total Payroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. (A) 2. (B)

2C. Payroll factor (divide A by B - calculate to six decimal places) . . . . � X 5 = �

Real and Tangible Property Owned (Original Cost Value)

Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Buildings and Depreciable Assets . . . . . . . . . . . . . . . . . . . . . . . .

Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Real and Tangible Personal Property . . . . . . . . . . . . . . . .

Partnership’s Share of Property Owned by Investee Partnerships . .

Less Construction in Progress (if included above) . . . . . . . . . . . .

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total Beginning and End of Period . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average Value (1/2 of Above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add: Corporate Tangible and/or Real Property Rented* . . . . . . . . . .

Investee Partnership Tangible and/or Real Property Rented * . . .

Total Average Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*Eight times net annual rental rate (Submit Schedule)

1. (A) 1. (B)

1C. Property factor (divide A by B - calculate to six decimal places). . . . � X 5 = �

1007410051

1007410051 1007410051

PA SCHEDULE H-CorpCorporate Partner ApportionedBusiness Income (Loss)PA-20S/PA-65 H-Corp (05-10) (FI)2010 OFFICIAL USE ONLY

Complete this schedule to apportion business income (loss) for partners who are business entities only. This schedule should be provided to partners who are business entities. If thepartnership derives business income from sources within and outside Pennsylvania or totally within Pennsylvania, complete this schedule. Any partner who is a corporation willuse its share of the information provided in the calculation of its own apportionment factor.

Name as shown on PA-20S/PA-65 Information Return Date the taxable period ended FEIN

Apportionment for (Tax Type)

Inside PA

Inside PA

Inside PA

Inside and Outside PA



End of PeriodBeginning of Period End of PeriodBeginning of Period

TABLE 1 – PROPERTY FACTOR Description

TABLE 2 – PAYROLL FACTOR Description

TABLE 3 – SALES FACTOR Description

Sales (Net of Returns and Allowances) . . . . . . . . . . . . . . . . . . . . . . .

Interest, Rents, Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gross Sales Price of Assets (Except securities) . . . . . . . . . . . . . . . .

Other Sales (receipts only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partner’s share of sales from partnerships . . . . . . . . . . . . . . . . . . . .

Total Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. (A) 3. (B)

3C. Sales factor (divide A by B - calculate to six decimal places) . . . . � X 90 = �

( ) ( ) ( ) ( )

Capital Stock/Foreign Franchise and Corporate Net Income Taxes Capital Stock/Foreign Franchise Tax Only Corporate Net Income Tax Only

Special Apportionment to be completed only by railroad, truck, bus, and airline entities, pipeline or natural gas entities and water transportation entities.(Refer to PA-20S/PA-65 Schedule H-Corp instructions) (A)

(B)= �

(A) Numerator

(B) Denominator

1007610056

1007610056 1007610056

OFFICIAL USE ONLY2010

PARTNER/MEMBER/SHAREHOLDER DIRECTORYPA-20S/PA-65Directory (05-10) (FI)

The entity must list its partners/members/shareholders on this schedule. Enter the following for all partners/members/shareholders:

SSN/FEIN; PA ACCOUNT #; OWNERSHIP % (enter each owner’s percentage); and NAME AND ADDRESS. Copy Directory to list additional owners.

CODE - Enter the type of owner by code. See instructions. RI = Resident Individual C = C CorporationB = Bank/Financial Institution I = Insurance Company L = LLC taxed as a Partnership NR = Nonresident IndividualPI = Part-year Resident Individual (S Corp Only) P = Partnership LC = LLC taxed as a C Corporation E = EstateT = Trust S = S Corp LS = LLC taxed as an S Corporation X = Exempt

Code SSN/FEIN Ownership %PA Account #1.

Name: Address:


Name: Address:


Name: Address:


Name: Address:


Name: Address:


Name: Address:

C

FEINName as shown on the PA-20S/PA-65 Information Return

PA SCHEDULE NWNonresident Withholding PaymentsPA S Corporations and PartnershipsPA-20S/PA-65 NW (05-10) (FI)

1008410050

OFFICIAL USE ONLY2010

Nonresident Withholding Payments PA S Corporations and PartnershipsUse this schedule to list all the withholding and extension payments that the PA S corporation, partnership or limited liability company filing as a partnership orPA S corporation for federal income tax purposes made on behalf of individual shareholders or partners, estates or trusts that were not residents of Pennsylvaniaduring the taxable year.

A.

B.

C.

PA Tax Due on PA-Taxable Income to Nonresident Individuals, Estates, or Trusts. . . . . . . . . . . . . . . . . . . . . . . . . . . A.

Total Nonresident Withholding Payments and Extension Payment. Enter here and on the PA-20S/PA-65 InformationReturn, Part V, Line 14a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.

Reconciliation Payment. Subtract B from A, and enter here and on the PA-20S/PA-65 Information ReturnPart V, Line 14b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C.Pay any balance due with:

• The PA-20S/PA-65 Information Return, or

• The PA-40 NRC, Nonresident Consolidated Tax Return, if all the nonresident individual owners elect to participate in a group return.

Nonresident Withholding Payments and Extension Payment during the Entity’s Taxable Year:

Date Amount Date Amount

$

$

$


1008410050 1008410050

Income from PA S corporation(s) and partnership(s), from your PA-20S/PA-65 Schedule(s) RK-1 or NRK-1.

Total Estate or Trust Income.Column (c) - Total Column (c) and enter the amount on the PA-20S/PA-65 Information Return, Part III, Line 7b.Column (d) - Total Column (d), subtract Column (c) from Column (d) and enter difference on the PA-20S/PA-65Information Return, Part III, Line 7a.

2010

PA SCHEDULE JIncome from Estatesand Trusts PA-20S/PA-65 J (05-10) (FI) OFFICIAL USE ONLY

List the name, address, and identification number of each estate or trust. Check box if income is reported from PA-41 Schedule RK-1 and NRK-1. If you receiveda federal Schedule K-1 instead of a PA-41 Schedule RK-1 and NRK-1, indicate if the income is PA-source or total.


1008910059

1008910059 1008910059

PA-41Schedule

RK-1/NRK-1(a) Name and address of each estate or trust (b) Federal EIN (c) PA-Source Income (d) Total Income

Everywhere

You must submit the certificate or notification that approved each credit you are claiming.

1. PA Employment Incentive Payments Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. PA Job Creation Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3. PA Research and Development Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

4. PA Film Production Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

5. Out-of-State Credits – S Corporation Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

6. PA Organ and Bone Marrow Donor Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.

7. PA Keystone Innovation Zone (KIZ) Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.

8. PA Resource Enhancement and Protection (REAP) Tax Credit . . . . . . . . . . . . . . . 8.

9. PA Neighborhood Assistance Program (NAP) Tax Credit . . . . . . . . . . . . . . . . . . . . 9.

10. PA Strategic Development Area (SDA) Job Creation Tax Credit . . . . . . . . . . . . . . 10.

11. PA Educational Improvement Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.

12. Total PA Other Credits. Add Lines 1 through 11 and enter total here . . . . . . . . . . . . 12.

2010PA SCHEDULE OCOther CreditsPA-20S/PA-65 OC (05-10) (FI)

1008310052

10083100521008310052

OFFICIAL USE ONLY

FEINName as shown on the PA-20S/PA-65 Information Return

1008810051

10088100511008810051

OFFICIAL USE ONLY

• PA-Source Winnings - In Column (a), report all taxable gambling and lottery winnings from sources within Pennsylvania.

• Total Winnings - In Column (b), report all taxable gambling and lottery winnings from all sources, whether receiving a federalForm W-2G or not.

1. Enter your total winnings from all federal Forms W-2G. 1.

2. Enter your total winnings from all other gambling, betting, 2.and lottery activities. Include cash and the fair market valueor stated value of property, trips, services, etc.

3. Total Winnings. 3.Add Lines 1 and 2.

4. Enter your total costs for tickets, bets, and other wagering. 4.Do not include any expenses (travel, meals, programs, tip sheets, etc.) you incurred to play a game of chance.

5. Total gambling and lottery winnings. Subtract Line 4 from Line 3. 5.Enter the amount from Column (a) on the PA-20S/PA-65Information Return, Part III, Line 8b. Subtract Column (a) fromColumn (b) and enter the difference on the PA-20S/PA-65Information Return, Part III, Line 8a.


(a) PA-Source Winnings (b) Total Winnings Everywhere

2010

PA SCHEDULE TGambling and Lottery WinningsPA-20S/PA-65 T (05-10) (FI)

Amended Schedule

Limited Partneror Other LLCMember

General Partneror LLC Member- Manager

14 Distributions from PA Accumulated Adjustments Account . . . .

15 Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If liquidating, fill in the oval.

2010

PA SCHEDULE RK-1Resident Schedule ofShareholder/Partner/BeneficiaryPass Through Income, Lossand Credits (05-10) (FI)

1007210055

10072100551007210055

FEIN

FEIN

SSN

PA Account #

1 PA-Taxable Business Income (Loss) from Operations . . . . . . . . . . .

2 Interest Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Net Gain (Loss) from the Sale, Exchange or Disposition of Property . . . . . .

5 Net Income (Loss) from Rents, Royalties, Patents and Copyrights . . . . . . . .

6 Income of/from Estates or Trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Gambling and Lottery Winnings (Loss) . . . . . . . . . . . . . . . . . . . . . . .

8 Resident Credit. Submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 Total Other Credits. Submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Distributions of Cash, Marketable Securities, and Property - not including guaranteed payments . . .

11 Guaranteed Payments for Capital or Other Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 All Other Guaranteed Payments for Services Rendered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13 Guaranteed Payments to the Retired Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 Nontaxable income or nondeductible expenses required to . . . . . . . . .calculate owner’s basis. Submit statement.

If a loss, fill in the oval.




1

8

9

10

11

12

13

14

15

16

2

3

4

5

6

7

Spouse’s SSNIf jointly held

Last Name

Name of Entity Issuing RK-1




State ZIP Code

Suffix First Name M I

City or Post Office

17 Owner’s Share of IRC Section 179 allowed according to PA rules . . . . . . . . . . . . . . . . . . . . . . . . . .

18 Owner’s Share of Straight-Line Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 Partner’s Share of Nonrecourse Liabilities at year-end . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20 Partner’s Share of Recourse Liabilities at year-end . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Partnership

LLC

Estate/Trust

Entity: (Fill in one oval only)

Final Owner:

PA S Corp.

All Other Corp.

Estate/Trust

Partnership

LLC

Exempt Org.

Fiscal Year

IndividualShareholder’s stock ownership: ________%

Beneficiary’s year-end distribution: ________%

Partner’s percentage of:

Profit sharing: ________%

Loss sharing: ________%

Ownership of capital: ________%

Par

t I.

Gen

eral

Inf

orm

atio

n

Phone NumberName of Owner Receiving RK-1 (if other than an individual)

Par

t II

Par

t II

IP

art

IVP

art

VP

art

VI

Par

t V

II

EndBegin

PA S Corp

Partner:

17

18

19

20

Enter whole dollars only


NOTE: Amounts from this schedule must be reported on the appropriate PA Tax Return.

PA SCHEDULE NRK-1Nonresident Schedule ofShareholder/Partner/BeneficiaryPass Through Income, Loss,and Credits (05-10) (FI)

8 Distributions of Cash, Marketable Securities, and Property - not including guaranteed payments . . . .

9 Guaranteed Payments for Capital or Other Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 All Other Guaranteed Payments for Services Rendered (PA-Apportioned Amount Only) . . . . . . . . .

11 Guaranteed Payments to the Retired Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 Owner’s Share of IRC Section 179 allowed according to PA rules . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 Owner’s Share of Straight-Line Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 Partner’s Share of Nonrecourse Liabilities at year-end . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 Partner’s Share of Recourse Liabilities at year-end . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

16

Par

t V

II

12 Distributions from PA Accumulated Adjustments Account . . . . . . .

13 Distributions of Cash, Marketable Securities, and Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2010

1007310053

1007310053 1007310053

1 PA-Taxable Business Income (Loss) from Operations . . . . . . . . . . . . .

2 Net Gain (Loss) from the Sale, Exchange or Disposition of Property . .

3 Net Income (Loss) from Rents, Royalties, Patents and Copyrights . . .

4 Income of/from Estates or Trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Gambling and Lottery Winnings (Loss) . . . . . . . . . . . . . . . . . . . . . . . .

6 PA Nonresident Tax Withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Total Other Credits. Submit statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14 Nontaxable income or nondeductible expenses required to . . . . . . . . . . . .calculate owner’s economic investment. Submit statement.





If liquidating, fill in the oval.

1

6

7

9

8

10

11

12

13

14

2

3

4

5

Par

t II

Par

t II

IP

art

IVP

art

VP

art

VI

FEIN

FEIN

SSN

PA Account #

Spouse’s SSNIf jointly held

Last Name

Name of Entity Issuing NRK-1




State ZIP Code

Suffix First Name M I

City or Post Office

Partnership

LLC

Estate/Trust

Entity: (Fill in one oval only)

Final Owner:

PA S Corp.

All Other Corp.

Estate/Trust

Partnership

LLC

Exempt Org.

Fiscal Year

Individual

Limited Partneror Other LLCMember

General Partneror LLC Member- Manager

Amended Schedule

Shareholder’s stock ownership: ________%

Beneficiary’s year-end distribution: ________%

Partner’s percentage of:

Profit sharing: ________%

Loss sharing: ________%

Ownership of capital: ________%

Par

t I.

Gen

eral

Inf

orm

atio

n

Phone Number

EndBegin

PA S Corp

Name of Owner Receiving NRK-1 (if other than an individual)

Partner:

17

18

Enter whole dollars only


NOTE: Amounts from this schedule must be reported on the appropriate PA Tax Return.

Amended Return

Total Number ofNonresident Individuals

Submit PA-40Schedule NRC-I

PA-40 NRCNonresident ConsolidatedIncome Tax ReturnPA-40 NRC (05-10) (FI)

1007510058

10075100581007510058

OFFICIAL USE ONLY2010TYPE OF BUSINESS ENTITY (FILL IN ONE OVAL)

P S L

Partnership PA S Corp LLC

Business Activity

SIGN THIS RETURN. Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and state-ments, and to the best of my belief, it is true, correct, and complete.

ENTER AMOUNTS FROM AND SUBMIT THE PA SCHEDULE NRK-1(S) OF THE ELECTING ELIGIBLE INDIVIDUALS

Number of Nonresident Individuals electing to file on this return

13b. Amount of Line 12 to be credited to the 2011 Nonresident Withholding Account . . . . . . . . . 13b.

Name of Preparer (If not the Tax Partner, Member, or Shareholder). PLEASE PRINT. Date Preparer's Telephone Number

Signature of General Partner, Principal Officer, or Authorized Individual Date Telephone Number

X

Final Return

Extension Requested

THIS FORM MAY BE USED FOR NONRESIDENT INDIVIDUAL PARTNERS/MEMBERS/SHAREHOLDERS.ENTER THE PARTNERSHIP, LLC OR PA S CORPORATION NAME AND FEIN.

DateOut-of-Existence

G

1. Apportioned Net Income (Loss) from the Operation of a Business, Profession,or Farm, plus electing partners guaranteed payments for services . . . . . . . . . . . . . . . 1.

2. Net Gain (Loss) from the Sale, Exchange, or Disposition of Property. . . . . . . . . . . . . . 2.

3. Net Income (Loss) from Rents, Royalties, Patents, and Copyrights,plus electing partners guaranteed payments for services . . . . . . . . . . . . . . . . . . . . . . . 3.

4. Estate or Trust Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4.

5. Gambling and Lottery Winnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

7. PA Tax Due Before Allowable Credits. Multiply Line 6 by the tax rate 3.07 percent . . . . . . . . .7.

8. Total PA Tax Withheld and Submitted from Electing Nonresident Individual Owners (Including Carryover Credit from the prior year) . . . . . . . . . . . . . . . . . . . . . . .8.

9. Total Other Credits. Submit a PA-20S/PA-65 Schedule OC with supporting statement. See PA-20S/PA-65 Schedule OC instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9.

10. Total PA Credits. Add Lines 8 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.

11. TAX DUE. If Line 7 is more than Line 10, enter the difference here. Make check payableto PA Dept. of Revenue. See final payment in the PA-20S/PA-65 instructions . . . . . . . . . . . .11.

12. OVERPAYMENT. If Line 10 is more than Line 7, enter the difference here. CompleteLine 13a and/or Line 13b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

13a. Amount of Line 12 to be refunded to the Partnership, LLC or PA S Corporation . . . . . . . . . 13a.

The TOTAL of Lines 13a and 13b MUST equal Line 12.

LOSS

LOSS

LOSS

LOSS

6. Total PA Taxable Income. Add the income on Lines 1 through 5. Do Not Add Losses . . . . . .6.

PA S Corporation Name or Partnership Name

ZIP CodeStateCity or Post Office


FEIN


EC FCOFFICIAL USE ONLY

PA SCHEDULE NRC-IDirectory of Nonresident Owners (Individuals)PA-40 NRC-I (05-10) (FI) 2010

1008010058

1008010058 1008010058

OFFICIAL USE ONLY

G

Name as shown on PA-20S/PA-65 Information ReturnFEIN

Directory of Nonresident Owners (Individuals)

List every nonresident individual owner who received a PA-20S/PA-65 Schedule NRK-1 from the PA S corporation, partnership or limitedliability company. Check the block for nonresident individuals participating in the PA-40 NRC. Do not use more than one line per entry. Ifadditional space is required, make copies of this schedule.

IMPORTANT: The entity must complete this directory and submit only the PA-20S/PA-65 Schedules NRK-1 for each nonresident individualelecting to file on the PA-40 NRC. DO NOT USE THIS SCHEDULE TO LIST ENTITIES.

Nonresident Individual Owners ENTER WHOLE DOLLARS ONLY

Social Security NumberCheck if filing

Last NameFirst Owner’s percentage of Tax withheld for

on PA-40NRC: � Initial Ownership Liabilities each Owner

Total =

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

Amended Schedule

Directory of Nonresident Owners (Other Entities)

List every nonresident or foreign owner that is not an individual that received a PA-20S/PA-65 Schedule NRK-1 or PA-20S/PA-65 Schedule

H-Corp if owner is a corporate partner. Do not use more than one line per entry. Enter the type of entity for each owner. If additional space

is required, make copies of this schedule. DO NOT USE THIS SCHEDULE TO LIST INDIVIDUALS.

Other Nonresident Owners

Owner’s percentage of Type ofFEIN Name

Ownership Liabilities Entity

PA SCHEDULE NRC-ODirectory of Nonresident and ForeignOwners (Other Entities)PA-40 NRC-O (05-10) (FI) 2010

1007910050

10079100501007910050

G

Name as shown on PA-20S/PA-65 Information ReturnFEIN

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

Type of Entity: S = PA S Corporation C = Corporation L = Limited Liability Company Taxed as a Partnership

E = Estate T = Trust LC = Limited Liability Company Taxed as a C Corporation

P = Partnership I = Insurance Company LS = Limited Liability Company Taxed as an S Corporation

X = Exempt Org. B = Bank/Financial Institution

Amended Schedule

page 1 of 3 (05-10) (fi 2010 - pstap

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