OFFICIAL USE ONLY Net Income or Loss from the Operation of a Business, Profession or Farm. 1300110028 1300110028 (06-13) 1300110028 Extension. Amended Return. Residency Status. Suffix R N P MI OVERSEAS MAIL - MI Suffix /2013 to /2013 Filing 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. 11. . . . . . . . . . . . . . . . . . . . . . 11. ECFC 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 submitPA Schedule J. Gambling and Lottery Winnings. Complete and submitPA 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 ForeignAddress 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 CAREFULLY 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 thePA Breast Cancer Coalition’s Refunds For Breast and Cervical Cancer Research Fund. Amount of Line 29 you want to donate to theWild Resource Conservation Fund. Amount of Line 29 you want to donate to the Assistance Program. Amount of Line 29 you want to donate to theGovernor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. Amount of Line 29 you want to donate to theJuvenile (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 yourPA 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 SPUnmarried 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----------------