2. If you answered “Yes” above, does the taxpayer on whose return you are a dependent qualify for tax forgiveness? 1. Age Relationship 2013 1301110027 Y es No No 1. a. b. S SN: Name: 2. 3. Ma rried - a. b. c. SSN: Name: d. C 4. : 2. . . . . . . . 2. Spouse 1. 1. 2. 2. 3. Alimony 3. 4. 4. 5. 5. 6. 6. 7. 7. 8. 8. 9. 9. 10. 10. 1 1. for for 1 1. 12. 12. 13. 13. 14. 14. 15. 15. 16. 16. Name of taxpayer claiming Tax Forgiveness (if filing a PA-40 jointly, enter the name shown first) Social Security Number (shown first) Spouse’s Name (even if filing separately) Spouse’s Social Security Number Eligibility Questions 1. Are you a dependent on another taxpayer’s (parent, guardian, step-parent, etc.) federal tax return? Only Column A Eligibility Income. If you answered “No” to Question 1, please proceed with completing Schedule SP. If you answered "Yes" to Question 1, you must also have answered “Yes” to Question 2 to be eligible for tax forgiveness and complete Line 1b. or Line 3c. from Part A below. Part A. Filing Status for Tax Forgiveness. Fill in the Married oval on Line 19a of your PA-40. Enter your spouse’s name and SSN above. Fill in the oval that describes your situation: Fill in this oval only if (a) you are separated pursuant to a written agreement or (b) you were married, but separated and lived apart for the last six months of the year. Fill in the Unmarried oval on Line19a of your PA-40. Separated – use to calculate your Eligibility Income. Unmarried - use Column A to calculate your Fill in the Unmarried oval on Line 19a of your PA-40. Fill in the oval that describes your situation: Single. Unmarried/divorced on Dec. 31, 2013 Single and claimed as a dependent on an other person’s PA Schedule SP. Enter the other person’s: Married and claiming Tax Forgiveness together with my spouse. Use Column A to calculate Married and filing separate PA tax returns. Fill in this oval certifying that you and your spouse are submitting the same information on each PA Schedule SP. Use Columns B and C to calculate your Eligibility Income. Married with a spouse who is a dependent on another person’s PA Schedule SP or federal income tax return. Use Columns B and C to calculate Eligibility Income. Enter the other person’s: Separated and lived apart from my spouse but for less than the last six months of the year. Use Columns B and to calculate Eligibility Income. Enter your spouse’s name and SSN above. Deceased - use Column A to calculate your Eligibility Income. Fill in the Deceased oval on Line 19a of the PA-40. You must annualize the decedent’s income (see the instructions) and briefly describe your method : Provide all the information for each dependent child. If more than four dependent children, submit additional sheets in this format. Part B. Dependent Children. Dependent’s Name Social Security No. claimed as your dependent(s) on your 2013 Federal Income Tax return. Number of dependent children. Enter on Line 19b of your PA-40. Part C. Eligibility Income. Married taxpayers filing separately, and taxpayers separated but not for the last six months of the year use Columns B and C, and Eligibility Income Table2. Married taxpayersfiling jointly use Column A and Eligibility Income Table 2. Single filers, qualifying separated filers, and if filing for a decedent use Column A and Eligibility Income Table1. The Eligibility Income Tables are on page 36 of the PA-40 booklet. Column A Unmarried or Married Filing Jointly Married Filing Separately Column B Column C Taxpayer PA taxable income from Line 9 of your PA-40 Nontaxable interest, dividends and gains and/or annualized income Insurance proceeds and inheritances Gifts, awards and prizes Nonresident income – part-year residents and nonresidents Nontaxable military income – Do not include combat pay Gain excluded from the sale of a residence Nontaxable educational assistance Cash received for personal purposes from outside your home Total Eligibility Income Column A PA Tax Liability from your PA-40, Line12 (if amended return, see instructions) Less Resident Credit from your PA-40, Line 22 Net PA Tax Liability. Subtract Line 13 from Line 12 Percentage of Tax Forgiveness from the Eligibility Income Table using your dependents from Part B and your Total Eligibility Income from Line 11 Tax Forgiveness Credit. Multiply Line 14 by the decimalon Line 15. Enter on your PA-40, Line 21. Part D. Calculating your Tax Forgiveness Credit Total Eligibility Income Columns B and C – add Lines 1 through 10 for each spouse and enter the total PA SCHEDULE SP Special Tax Forgiveness PA-40 Schedule SP OFFICIAL USE ONLY IMPORTANT (06-13) Yes IMPORANT: Eligibility Income. Certification. ----------------Page (0) Break----------------