Form RCT-101D Fillable Declaration of de minimis Pennsylvania Activity (RCT-101D)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

the above mentioned corporation's activity in the Commonwealth (ACCOUNT ID pages 1 2 and 3) (Address Line 1) (Address Line 2) (arrow) (combobox) (DATE) (DATE) DO NOT PLACE ANY DASHES ( ) OR SLASHES (/) IN THE FIELDS (E Mail) (Federal EIN 9) (FILL IN FORM USING ALL CAPS) FILL IN FORM USING ALL CAPS (Name pages 1 2 and 3) (Name) (PHONE/page 1) (print) PRINT FORM (reset entire form) Reset Entire Form (RETURN TO TOP) RETURN TO TOP (Signature) PLEASE SIGN THIS RETURN AFTER PRINTING (Start Box) START (State) (Tax Year Beginning) (Tax Year Ending) (text) (text) (text) (text) (text) (Zip) 1014012105 Address Change Address Line 1 XX Address Line 2 XX and ending City XX Corporate Officer Signature Corporation Name XX Declaration of de minimis Pennsylvania Activity DEPARTMENT USE ONLY During the tax period beginning EMAIL Federal EIN XX I affirm under penalties prescribed by law this declaration including any accompanying schedules and statements has been examined by me and to the best Interpretation and De Minimis Standards Based on this activity this corporation is not required to file a PA franchise tax loans tax and/or corporate net income tax report for this period of my knowledge and belief is a true correct and complete declaration of Pennsylvania did not exceed the de minimis activities outlined in Part II of Corporation Tax Bulletin 2004 01 issued April 13 2004 and titled PL 86272 Parent Corporation EIN PHONE RCT 101D (FI) (06 12) Revenue ID XX Revenue Miles Everywhere Revenue Miles in PA Number of Days in PA State XX STEP A STEP B STEP C: Affirmation and Signature of Corporate Officer Tax Year Beginning Tax Year Ending the filing of a tax return based solely upon de minimis activities Further for the taxpayer to utilize any tax benefits generated in this period the taxpayer The undersigned acknowledges that de minimis levels of activity are sufficient to subject a corporation to tax but the department has elected not to require Total PA Sales Transportation Companies (Truck and Bus Companies) Non transportation Companies Trips into PA will be required to file a complete RCT 101 PA Corporate Tax Report for this period and pay any tax due ZIP XX