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OFFICIAL USE ONLY Net Income or Loss from the Operation of a Business, Profession or Farm. 13 00110028 13 00110028 (0 6 - 13) 13 00110028 E xtension. A mende d Return . R esidency Sta tus. Su f f ix R N P MI OVERSEAS MAIL - MI Su f f ix /2013 to / 2013 F iling Status. S Single J M F D / 2013 Spouse /2013 State ZIP Code Farmers. 1a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . . 1a. 1b. 1c . 2. 3. 4. . . . 5. . . . . . . . . LOSS 4. 5. 6. . . . . . . . . . . . LOSS 6. 7. . . . . . . . . . . . . . . . . . . . . 8. . . . . . . . . . . . . . 9. . . . . . . . . . . . . . . 10. Other Deductions. . . . . . . . . . . . . . . . . . . . . . . . . 7. 8. 9. 10. 1 1. . . . . . . . . . . . . . . . . . . . . . 11. EC FC Your Social Security Number Spouse’s Social Security Number (if filing jointly) Last Name Your First Name Spouse’s First Name First Line of Address Second Line of Address City or Post Office Daytime Telephone Number School Code See the instructions. Fill in only one oval. Pennsylvania Resident Nonresident (Not Supported) Part-Year Resident from (Not Supported) Married, Filing Jointly Married, Filing Separately Final Return. Indicate reason: Deceased Taxpayer Date of death Date of death Fill in this oval if at least two-thirds of your gross income is from farming. Name of school district where you lived on 12/31/2013: Your occupation Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. Unreimbursed Employee Business Expenses. Net Compensation. Subtract Line 1b from Line 1a. Interest Income. Complete PA Schedule A if required. Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. Net Gain or Loss from the Sale, Exchange or Disposition of Property. Net Income or Loss from Rents, Royalties, Patents or Copyrights. Estate or Trust Income. Complete and submit PA Schedule J. Gambling and Lottery Winnings. Complete and submit PA Schedule T. Total PA Taxable Income. Add only the positive income amounts from Lines 1c, 2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6. Enter the appropriate code for the type of deduction. See the instructions for additional information. Adjusted PA Taxable Income. Subtract Line 10 from Line 9. Side 1 OFFICIAL USE ONLY See Foreign Address Instructions in PA-40 booklet. PA-40A 2013 Pennsylvania Income Tax Return PA Department of Revenue, Harrisburg, PA 17129 PLEASE PRINT IN BLACK INK. ENTER ONE LETTER OR NUMBER IN EACH BOX. FILL IN OVALS COMPLETELY. Spouse’s occupation CARE FULLY PRINT YOUR SOCIAL SECURITY NUMBER(S) ABOVE LOSS Spouse’s Last Name - Only if different from Last Name above See the instructions. (Not Supported) (Not Supported) ----------------Page (0) Break---------------- Credit Your Signature Firm FEIN Tax Forgiveness Credit 1300210026 1300210026 12. . . . . . . . . . . . . . . . . . . . . . 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. . . . . 18. . . . . . . . . . . . . 12. 13. 14. 15. 16. 17. 18. 19a. Married Deceased Separated 19b. . . . . . . . . . . . . . . 21. . . . . . . . . . . . . . . . . . . 22. and/or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. 22. 23. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. 24. . . . . . . . . . . . . . . 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27. 24. 25. 26. . . . . . 27. 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30. . . . . . . . . . REFUND 31. . . . . 32. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33. . . . 34. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35. . . . . . . . . . . . . . . . . . . . . . . . . . 36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. 29. 30. 31. 32. 33. 34. 35. 36. Date PA Schedule(s) G-R with your PA Schedule(s) G-S, G-L, RK-1 PA Schedule OC TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23. USE TAX. TAX DUE. If the total of Line 12 and Line 25 is more than Line 24, enter the difference here. Penalties and Interest. See the instructions for additional information. Fill in oval if including Form REV-1630/REV-1630A TOTAL PAYMENT DUE. See the instructions. OVERPAYMENT. If Line 24 is more than the total of Line 12, Line 25 and Line 27 enter the difference here. The total of Lines 30 through 36 must equal Line 29. Refund Amount of Line 29 you want to donate to the PA Breast Cancer Coalition’s Refunds For Breast and Cervical Cancer Research Fund. Amount of Line 29 you want to donate to the Wild Resource Conservation Fund. Amount of Line 29 you want to donate to the Assistance Program. Amount of Line 29 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. Amount of Line 29 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund PLEASE DO NOT CALL ABOUT YOUR REFUND UNTIL EIGHT WEEKS AFTER YOU FILE. PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). Credit from your 2012 PA Income Tax return. 2013 Estimated Installment Payments. Fill in oval if including Form REV-459B. 2013 Extension Payment. Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17. Social Security Number (shown first) Name(s) Dependents, Part B, Line 2, PA Schedule SP Unmarried or Tax Forgiveness Credit, submit PA Schedule SP 20. Total Eligibility Income from Part C, Line 11, PA Schedule SP from Part D, Line 16, PA Schedule SP Total Other Credits. Submit your Add amount. See the instructions. – Amount of Line 29 you want as a check mailed to you – Amount of Line 29 you want as a credit to your 2014 estimated account. Military Family Relief (our) belief, they are true, correct, and complete. Preparer’s PTIN Preparer’s Name and Telephone Number Spouse’s Signature, if filing jointly See the instructions. Total PA Tax Withheld. See the instructions. Filing Status: PA-40 2013 1300210026 (06-13) Resident Credit. Submit your SIGNATURE(S). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all accompanying schedules and statements, and to the best of my E-File Opt Out Side 2 (Not Supported) . . . .. . . . . .. . . . . .. . . . . .. . ----------------Page (1) Break----------------