Form Rct-128c - Report Of Change In Corporate Net Income Tax Page 3

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1283015305
REVENUE ID
TAX YEAR END
NAME
RCT-128C
PAGE 3 OF 3 REPORT OF CHANGE IN CORPORATE NET INCOME TAX
(FI)
DETERMINATION OF APPORTIONMENT PERCENTAGES
From RCT-106, applicable for the tax year being reported
SCHEDULE C-1: Apportionment Schedule For Corporate Net Income Tax (Include Form RCT-106.) See instructions for apportionment in the
CT-1 PA Corporation Tax Instructions, REV-1200, found at
Three-Factor
1A
Property - PA
1D
1B
Property - Total
2A
2D
Payroll - PA
2B
Payroll - Total
3A
3D
Sales - PA
3B
Sales - Total
Single-Factor
4A
5
Apportionment
Numerator
Proportion
4B
Denominator
CORPORATE OFFICERS
SSN
Last Name
First Name
MI
Must provide requested information
for all filled officer positions
XX
President/Managing Partner
XX
Vice President
XX
Secretary
XX
Treasurer/Tax Manager
PREPARER’S INFORMATION
XX
Mail to Preparer
XX
Firm Federal EIN
XX
Firm Name
XX
Address Line 1
XX
Address Line 2
XX
City
XX
State
XX
ZIP
I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been prepared by me and to the best of my
knowledge and belief is a true, correct and complete report.
Tax Preparer’s Signature
Date
PLEASE SIGN AFTER PRINTING.
INDIVIDUAL PREPARER
PHONE
EMAIL
PTIN/SSN
PRINT FORM
Reset Entire Form
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RETURN TO PAGE ONE
1283015305
1283015305

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