Beneficiary Information: Contributions by: 

Name:     Spouse 

 1.   

    

    

    

    

    

    

    

    

    

              

  2. 

  

 

 

 

   

  

1301610026 

   - 2013     

               

 

   

                 

 

 

1.  

 

 

 

 

 

 

 

 

 

 

 

 

 

2.  

 

      

3.           3.   

4.           4.   

5.                 5.   

6.               6.   

7.              7.   

 8.                 

         8. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1301610026 1301610026 

PA SCHEDULE O

Other DeductionsPA-40 Schedule O

(06-13)OFFICIAL USE ONLY

Name shown first on the PA-40 (if filing jointly)  Social Security Number (shown first)

(See the instructions.)

additional schedules).

Medical Savings Account contributions allowed for federal purposes.

Health Savings Account contributions allowed for federal purposes.

Enter here and on Line 10 of your PA-40.

PART I - IRC Section 529 Qualified Tuition Program Contributions(Limit $14,000 per beneficiary, per taxpayer-spouse.)

Add Lines 2, 3 and 4 and enter amounts here for tax payer and/or spouse.

Total income reported on PA-40 Line 9 by taxpayer and spouse separately.

Lesser of Line 5 or Line 6 for taxpayer and/or spouse.

- Add the amounts from Line 7 for taxpayer and/or spouse together.Total Other Deductions

PART II - Other Deductions and Limitations

Total IRC Section 529 Contributions

Social Security NumberTaxpayer

- Add all amounts listed (including amounts on

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