(PT) 10-19                              START    BUSINESS NAME: 
                                                     TAX WORKSHEET FOR            Ü
                   REV-1190                          PA-20S/PA-65 SCHEDULE M, 
                   Po BoX 280509 
                   HarrisBurg, Pa  17128-0509        PART II, SECTION V, LINE a            FEIN:

SECTION I             TAXES DEDUCTED ON FEDERAL RETURN (Excluding Sales/Use Taxes)
  a.    Federal Form 1065 - Line 14 
  b.    Federal Form 1065 - Tax included in federal Form 1125-A 
   c.    Federal Form 1120S - Line 12 
  d.    Federal Form 1120S - Tax included in federal Form 1125-A 
  e.    Total taxes deducted on federal return 

SECTION II            DETAIL OF TAXES DEDUCTED (In Section I)

                                                     COLUMN 1         COLUMN 2                            COLUMN 3
            TAXING      DESCRIPTION                                   PORTION OF TAX IN COLUMN 1        PORTION OF TAX IN COLUMN 1 
                                                     TOTAL TAX
           JURISDICTION OF TAX                                        NOT BASED ON NET INCOME           BASED ON NET INCOME
1.          

   2.      
   3.      
   4.      
   5.      
   6.      
   7.      
   8.      
   9.      
 10.      
  11.      
 12.      
 13.      
 14.      
 15.      
 16.      
 17.      
 18.      
 19.     Attach separate sheet if needed. 
 20.     TOTAL TAXES                                 $$                                                 $ 
                                                     This amount must This amount is deductible for     Report on PA-20S/PA-65  
                                                     equal the amount  Pennsylvania personal income tax Schedule M, Part II, Section V,  
                                                     in Section I,    purposes and federal income tax     Line a.
                                                     Line e above.                purposes.

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