Line 1a

If you need more space, you may photocopy this schedule or make your own schedules in this format.

Security Number that appears first on the PA tax return and enter S for the second or spouse SSN. From the Forms W-2, enter each employer’s federal identification number.

YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART

  

   

   

1301910020 

PA-40 Schedule W-2S (06-13) 2013     

Summary of PA-Taxable Employee, Non-employee and Miscellaneous Compensation 

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

                                             

                                                           

                                                

                                                  

                                             

                          

                 

                

T/S                         

      

      

      

      

      

      

      

      

      

      

        

 

               

            

A. T/S B.  C. Payer name D.   E.    F.    G.   H.    

        

        

        

        

        

        

        

        

        

        

         

 

           

             

   A.   B.    C.   D.    

E. Honorarium F.     G.           

H.        

I.            

J.       K.         

L.      

  

 

 

1301910020 1301910020 

PA SCHEDULE W-2S

Wage Statement Summary

OFFICIAL USE ONLY

Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources.List each federal Form W-2 for you and your spouse, if married, received from your employer(s). In the first column enter T for the taxpayer’s Social 

Enter the amounts from the Forms W-2 in each column.IMPORTANT:You do not have to submit a copy of your Form W-2 if you earned all your income in Pennsylvania

See the PA Schedule W-2S instructions for a list of when a copy of a W-2 is required.a copy of your Form W-2 in certain circumstances. 

Part B Instructions:

IMPORTANT: must submitThe federal and Pennsylvania (state) wages may be different in Part A and Part B.

List each source of income received during the taxable year on a form or statement other than a federal Form W-2. Enter eachpayer’s name. List the 

does not have separately stated amounts, enter the amount shown in both federal and PA columns.payment type that most closely describes the source of your non-employee compensation. Enter the amount of other compensation that you earned. If the form or statement 

Part A - Federal Forms W-2SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S) W-2

Employer’s identification number from Box bFederal wages from Box 1Medicare wages from Box 5PA compensation PA incometax from Box 16withheld from Box 17

Total Part A - Add the Pennsylvania columns

Part B - Miscellaneous and Non-employee Compensation from federal Forms 1099-R,1099-MISC and other statements

1099R codeTotal federal amountPA tax withheldPA compensationAdjusted plan basis

Total Part B - Add the Pennsylvania columns

TOTAL- Add the totals from Parts A and B

Enter the TOTALS on your PA tax return on:Line 13

Payment type: Executor feeJury duty pay

Covenant not to compete

Director’s feeExpert witness fee

Damages or settlement for lost wages, other than personal injury

Other nonemployee compensation. Describe:

Distribution from employer sponsored retirement, pension or qualified deferred compensation plan

Distribution from IRA (Traditional or Roth)Distribution from Life Insurance, Annuity or Endowment Contracts

Distribution from Charitable Gift Annuities

Part A Instructions:

Younot the income was taxable in PA. a copy of each form and statement that you list in Part B, whether or not the payer withheld any PA income tax and regardless of whether orCAUTION: 

must submit and your employer reported your PA wages correctly and withheld the correct amount of PA income tax.You

Type

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