Pennsylvania Declaration of de minimis Pennsylvania Activity

Declaration of de minimis Pennsylvania Activity
Declaration of de minimis Pennsylvania Activity (RCT-101D)
FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
1014016105
1014016105

DEPARTMENT USE ONLY

rct-101D (FI) (05-16)
Declaration of de minimis Pennsylvania Activity
Step a
START

➜

PLEASE ENTER ALL DATES AS MMDDYYYY

Tax Year Beginning
Tax Year Ending

Step B
Address Change

Step c
Revenue ID
Federal EIN
Corporation Name
Address Line 1
Address Line 2
City
State
ZIP

Parent Corporation EIN

Province
Country Code
Foreign Postal Code

During the tax period beginning
and ending
, the above-named corporation's activity in the Commonwealth of
Pennsylvania did not exceed the de minimis activities outlined in Part II of Corporation Tax Bulletin 2004-01, issued April 13, 2004, and titled PL 86-272
Interpretation and De Minimis Standards. Based on this activity, this corporation is not required to file a PA corporate net income tax report for this period.

Transportation Companies (Truck and Bus Companies)

Non-transportation Companies

Revenue Miles in PA

Number of Days in PA

Revenue Miles Everywhere

Total PA Sales

Trips into PA
The undersigned acknowledges that de minimis levels of activity are sufficient to subject a corporation to tax, but the department has elected not to require
the filing of a tax return based solely upon de minimis activities. Further, for the taxpayer to utilize any tax benefits generated in this period, the taxpayer will
be required to file a complete RCT-101, PA Corporate Net Income Tax Report, for this period and pay any tax due.

Step D: corporate officer (must sign affirmation below)
name
phone
emaIl
I affirm under penalties prescribed by law, this declaration, including any accompanying schedules and statements, has been examined by me and to the
best of my knowledge and belief is a true, correct and complete declaration.

corporate officer Signature

Date
PLEASE SIGN AFTER PRINTING.

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