2109510053 2109510053 PA-40 SP (EX) MOD 06-21 (FI) PA Department of Revenue 2109510053 1. Unmarried - use Column A to calculate your Eligibility Income. Fill in the Unmarried oval on Line 19a of your PA-40. Fill in the oval that describes your situation: a. Single. Unmarried/divorced on Dec. 31, 2021 b. Single and claimed as a dependent on another person’s PA Schedule SP. Enter the other person’s: SSN: Name: 2. Separated – use Column A to calculate your Eligibility Income. Fill in this oval only if (a) you are separated pursuant to a written agreement or (b) you were married, but separated and lived apart for the last six months of the year. Fill in the Unmarried oval on Line 19a of your PA-40. 3. Married - Fill in the Married oval on Line 19a of your PA-40. Enter your spouse’s name and SSN above. Fill in the oval that describes your situation: a. Married and claiming Tax Forgiveness together with my spouse. Use Column A to calculate Eligibility Income. b. Married and filing separate PA tax returns. Certification. Fill in this oval certifying that you and your spouse are submitting the same information on each PA Schedule SP. Use Columns B and C to calculate your Eligibility Income. c. Married with a spouse who is a dependent on another person’s PA Schedule SP or federal income tax return. Use Columns B and C to calculate Eligibility Income. Enter the other person’s: SSN: Name: d. Separated and lived apart from my spouse but for less than the last six months of the year. Use Columns B and C to calculate Eligibility Income. Enter your spouse’s name and SSN above. 4. Deceased - use Column A to calculate your Eligibility Income. Fill in the Deceased oval on Line 19a of the PA-40. You must annualize the decedent’s income (see the instructions) and briefly describe your method: OFFICIAL USE ONLY 1. DEPENDENT’S NAME AGE 2. RELATIONSHIP SOCIAL SECURITY NO. 2. Number of dependent children. Enter on Line 19b of your PA-40. . . . . Provide all the information for each dependent child. If more than nine dependent children, submit additional sheets in this format. IMPORTANT: Only claim the child or children that you claimed as your dependent(s) on your 2021 Federal Income Tax return. Name of taxpayer claiming Tax Forgiveness (if filing a PA-40 jointly, enter the name shown first) Social Security Number (shown first) Spouse’s Name (even if filing separately) Spouse’s Social Security Number Eligibility Questions 1. Are you a dependent on another taxpayer’s (parent, guardian, step-parent, etc.) federal tax return? Yes No 2. If you answered “Yes” above, does the taxpayer on whose return you are a dependent qualify for tax forgiveness? Yes No IMPORTANT: If you answered “No” to Question 1, please proceed with completing Schedule SP. If you answered “Yes” to Question 1, you must also have answered “Yes” to Question 2 to be eligible for tax forgiveness and complete Line 1b. or Line 3c. from Section I below. PAGE 1 FILING STATUS FOR TAX FORGIVENESS SECTION I DEPENDENT CHILDREN SECTION II PA SCHEDULE SP Special Tax Forgiveness 2021 START § PRINT NEXT PAGE TOP OF PAGE Reset Entire Form IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING

PA-40 SP (EX) MOD 06-21 (FI) 2109610051 2109610051 2109610051 Taxpayer’s Social Security Number PAGE 2 12. PA Tax Liability from your PA-40, Line 12 (if amended return, see instructions) 12.

13. Less Resident Credit from your PA-40, Line 22 13.

14. Net PA Tax Liability. Subtract Line 13 from Line 12 14.

15. Percentage of Tax Forgiveness entered as a decimal from the Eligibility Income Table 15. using your dependents from Section II and your Total Eligibility Income from Line 11 16. Tax Forgiveness Credit. Multiply Line 14 by the decimal on Line 15. 16. Enter on your PA-40, Line 21. Taxypayer’s Name: Married taxpayers filing jointly use Column A and Eligibility Income Married taxpayers filing separately, and taxpayers separated but not for the last Table 2. Single filers, qualifying separated filers, and if filing for six months of the year use Columns B and C, and Eligibility Income Table 2. a decedent use Column A and Eligibility Income Table 1. COLUMN A The Eligibility Income Tables are on page 39 of the PA-40 booklet. MARRIED FILING SEPARATELY UNMARRIED OR MARRIED COLUMN B COLUMN C FILING JOINTLY TAXPAYER SPOUSE 1. PA taxable income from Line 9 of your PA-40 1.

2. Nontaxable interest, dividends and gains and/or annualized income 2.

3. Alimony 3.

4. Insurance proceeds and inheritances 4.

5. Gifts, awards and prizes 5.

6. Non-PA income – part-year residents and nonresidents 6.

7. Nontaxable military income – Do not include combat pay 7.

8. Gain excluded from the sale of a residence 8.

9. Nontaxable educational assistance 9.

10. Cash received for personal purposes from outside your home 10.

11. ÁTotal Eligibility Income for Column A

Total Eligibility Income for Columns B and C – add Lines 1 through 10 for each spouse and enter the total Ë 11. ELIGIBILITY INCOME SECTION III CALCULATING YOUR TAX FORGIVENESS CREDIT SECTION IV % % PRINT NEXT PAGE PREVIOUS PAGE Reset Entire Form

PA-40 SP 1 www.revenue.pa.gov 2021 Instructions for PA-40 Schedule SP Special Tax Forgiveness

PURPOSE OF SCHEDULE Use PA-40 Schedule SP to claim the Tax Forgiveness Credit for taxpayers who meet the qualifications to reduce all or a part of their Pennsylvania Tax Liability. Refer to the PA Personal Income Tax Guide – Tax Forgive­ ness section for additional information.

Show money amounts in whole-dollars only. Eliminate any amount less than $0.50 and increase any amount that is $0.50 or more to the next highest dollar.

PA-40 Schedule SP must be completed and included with an originally filed PA-40, Personal Income Tax Return, for any taxpayer(s) claiming the Tax Forgiveness Credit on Line 21 of the PA-40. An amended PA Schedule SP must be included with Sched­ ule PA-40 X if increases or decreases in income amounts or changes to any information in Sections I, II or III of PA Schedule SP are discovered after an original or other amended return is filed with the department. Section III on Page 2 of Schedule PA-40 X must be completed to explain any changes to the information on PA-40 Schedule SP re­ sulting in changes to the Tax Forgiveness credit reported on an amended PA-40, Personal Income Tax Return.

IDENTIFICATION INFORMATION NAME OF TAXPAYER CLAIMING TAX FORGIVENESS Enter the name of the taxpayer claiming Tax Forgiveness. If a jointly filed return, enter the name of the primary taxpayer (name shown first on the PA-40, Personal Income Tax Re­ turn). SPOUSE’S NAME Enter the spouse’s name if filing Married, Filing Jointly or Married, Filing Separately on the PA-40, Personal Income Tax Return. SOCIAL SECURITY NUMBER Enter the Social Security number (SSN) of the taxpayer. If a jointly filed return, enter the primary taxpayer’s SSN. SPOUSE’S SOCIAL SECURITY NUMBER Enter the spouse’s SSN even if filing Married, Filing Sepa­ rately.

WHAT IS TAX FORGIVENESS? Tax Forgiveness is a credit that allows eligible taxpayers to reduce all or part of their PA tax liability. Tax Forgiveness: ● Gives a state tax refund to some taxpayers; and ● Forgives some taxpayers of their liabilities even if they have not paid their PA personal income tax. WHO IS ELIGIBLE FOR TAX FORGIVENESS? A taxpayer and spouse, if applicable, are eligible if: 1. Subject to PA personal income tax. Taxpayer and spouse are liable for PA tax on income (or would be li­ able if earned, received, or realized PA-taxable income); 2. Not a dependent on another person's federal tax return; and 3. The eligibility income requirements are met. NOTE: A dependent child may also be eligible if he or she is a dependent on the PA-40 Schedule SP of his or her parents, grandparents, or foster parents. HOW DO I CLAIM TAX FORGIVENESS? To claim Tax Forgiveness, complete and submit a PA Sched­ ule SP, and: 1. Determine Eligibility Income. If married, whether filing Married, Filing Jointly or Married, Filing Separately, total or joint Eligibility Income must be determined in Section III (taxpayer Eligibility Income plus the spouse’s Eligibil­ ity Income). 2. Determine the Filing Status in Section I. 3. Calculate the Tax Forgiveness Credit, using the appli­ cable Eligibility Income Table, in Section IV. IMPORTANT: There is no advantage to filing separately because married claimants must report their Joint Eli­ gibility Income on PA Schedule SP. The spouse’s SSN must be included, even if filing Married, Filing Separately. CLAIMING DEPENDENTS ON SEPARATE PA SCHEDULES SP It is possible that a taxpayer and spouse file jointly for fed­ eral income tax purposes, but must file separately for Penn­ sylvania personal income tax purposes. If qualifying for Tax Forgiveness, the taxpayer and spouse must each complete PA-40 Schedule SP as if filing jointly. Each must report the same information including dependents and the joint Eligi­ bility Income. The Married and Filing Separate ovals in Sec­ tion I of each PA-40 Schedule SP must be completed. A copy of the PA-40 Schedule SP must be included with both PA-40, Personal Income Tax Returns, for the taxpayer and spouse. GENERAL INFORMATION RECORDING DOLLAR AMOUNTS WHO MUST COMPLETE FORM INSTRUCTIONS GENERAL INSTRUCTIONS PA-40 SP IN 06-21 NEXT PAGE PREVIOUS PAGE

PA-40 SP 2 www.revenue.pa.gov NONRESIDENTS AND PART-YEAR RESIDENTS Taxpayers who are nonresidents and part-year residents of Pennsylvania may claim Tax Forgiveness if meeting all the eligibility requirements. Such taxpayers must include in their Eligibility Income all income as described whether earned within or outside Pennsylvania. Nonresident and part-year resident taxpayers who file paper copies of the PA-40, Per­ sonal Income Tax Return, must also include a copy of pages one and two of their federal income tax return along with their completed PA-40 Schedule SP. CAUTION: Residents of reciprocal states that have Pennsylvania-taxable income in Pennsylvania classes of income other than compensation must also include all their nontaxable income earned outside Pennsylvania, as well as the compensation not taxable to Pennsylvania as a resident of a reciprocal state, on Line 6 of PA-40 Schedule SP.

Answer the question regarding if the taxpayer is a depend­ ent on another taxpayer’s (parent, guardian, grandparent, step-parent, etc.) federal tax return.

If yes is the answer on Line 1, answer the question regard­ ing whether the taxpayer on whose tax return the depend­ ency is claimed also qualifies for Tax Forgiveness. IMPORTANT: If “No” is the answer on Line 1, proceed with completing the remaining section of PA-40 Sched­ ule SP to determine eligibility for Tax Forgiveness. If “Yes” is the answer on Line 1 and Line 2, proceed with completing the remaining sections of PA-40 Schedule SP to determine eligibility for Tax Forgiveness. If “Yes” is the answer on Line 1 and “No” is the answer on Line 2, Tax Forgiveness may not be claimed.

FILING STATUS Fill in the oval(s) that accurately describe(s) the filing status as of Dec. 31 of the tax year.

Complete the unmarried oval on PA-40 Schedule SP if sin­ gle, widowed and could not or did not elect to file a joint re­ turn in the year of death of the taxpayer and/or spouse, or divorced on Dec. 31 of the tax year. Also complete the un­ married/separated oval on Line 19a of the PA-40, Personal Income Tax Return. LINE 1A Complete this oval if single, unmarried, divorced or widowed and could not or did not elect to file a joint return in the year of death of the taxpayer and/or spouse. LINE 1B Complete this oval claimed as a dependent on another per­ son’s PA-40 Schedule SP. Enter the other person’s SSN and name in the spaces provided. STUDENTS A full-time student who is a dependent on his/her parents’ federal income tax return cannot claim this credit, regardless of his/her income, unless his/her parents are eligible for Tax Forgiveness. In this case, the student claimant must file his/her own tax return and PA-40 Schedule SP.

Complete the separated oval on PA-40 Schedule SP only if separated and living apart at all times during the last six months of the tax year, or separated pursuant to a written sep­ aration agreement. Also complete the unmarried/separated oval on Line 19a of the PA-40, Personal Income Tax Return.

Complete the married oval on PA-40 Schedule SP if married and living together or a joint return was elected to be filed in the year of death of the taxpayer and/or spouse. Also com­ plete the married oval if filing married and living apart for less than the last six months of the tax year or were sepa­ rated, but not by a written separation agreement. In addition, complete the married oval on Line 19a of the PA-40, Per­ sonal Income Tax Return. LINE 3A Complete this oval if married and living together or a joint return was elected to be filed in the year of death of the tax­ payer and/or spouse. LINE 3B Complete this oval if married and filing separate PA-40, Per­ sonal Income Tax Returns. NOTE: Columns B and C must be completed in Sec­ tion III, Eligibility Income. CERTIFICATION Complete this oval if certifying the information included on each Schedule SP is the same. LINE 3C Complete this oval if married and the spouse is dependent on another person’s federal tax return. Enter the other per­ son’s SSN and name in the spaces provided. NOTE: Columns B and C must be completed in Sec­ tion III, Eligibility Income. LINE 3D Complete this oval if married and lived apart but not for the last six months of the tax year. NOTE: Columns B and C must be completed in Sec­ tion III, Eligibility Income. When claiming Tax Forgiveness together, either the tax­ payer or spouse must meet the eligibility requirements, but the Joint Eligibility Income and Eligibility Income Table 2 must be used. LINE INSTRUCTIONS ELIGIBILITY QUESTIONS LINE 1 LINE 2 SECTION I LINE 1 LINE 2 LINE 3 NEXT PAGE PREVIOUS PAGE

PA-40 SP 3 www.revenue.pa.gov When filing separately, the taxpayer and spouse must com­ bine their Eligibility Incomes to determine if they meet the eligibility requirements. A married taxpayer cannot claim Tax Forgiveness independently of his or her spouse. Married claimants are not dependents of one another for Tax For­ giveness purposes, even when one spouse does not have any Eligibility Income. Each must use the Joint Eligibility In­ come and Eligibility Income Table 2, and fill in the oval and certify that the same information for PA-40 Schedule SP is being used. When one spouse is claimed as a dependent on another person’s federal income tax return, otherwise qualifying mar­ ried taxpayers must file separately. EXAMPLE: Scott is a dependent on his parents’ federal in­ come tax return and is not eligible for Tax Forgiveness. His wife, Paula, is not a dependent, and may complete PA-40 Schedule SP. Paula may not claim Scott as a dependent, but must include his Eligibility Income when calculating her Total Eligibility Income. Additionally, if Scott’s parents qualify for Tax Forgiveness, Scott may also qualify if he included Paula’s income in his Total Eligibility Income.

Complete this oval if the tax return is being filed for a person who died during the tax year and/or the deceased person’s surviving spouse or deceased spouse could not or did not elect to file a joint return with the deceased taxpayer. Annu­ alization of a deceased taxpayer and/or spouse’s income may be required in order to determine total Eligibility Income for Tax Forgiveness purposes. Also complete the deceased oval on Line 19a of the PA-40, Personal Income Tax Return. ANNUALIZATION OF INCOME In order to determine eligibility for Tax Forgiveness, the Eli­ gibility Income for a complete year must be used as the ta­ bles in Section IV of PA-40 Schedule SP use an annual income amount in the calculation of the forgiveness factor. As a result, taxpayers that do not have a complete tax year’s income (usually deceased taxpayers) must annualize their income. To annualize a deceased taxpayer’s income, the in­ come realized by the decedent is divided by the number of days (or months) the decedent lived and multiplied by 365 days (or 12 months) may be used. From this product, sub­ tract the amount of realized income and include the remain­ der in the amount reported on Line 2 of Section III for PA-40 Schedule SP. One time transactions, such as those from the sale of stock or real property, need not be included when determining the amount of the realized income before mul­ tiplying by the number of days or months in the tax year. Realized income includes Pennsylvania-taxable income and any other eligibility income listed on Lines 2 through 10 for Section III of PA-40 Schedule SP. Separate calculations of annualized income amounts may be required for each of the Lines 2 through 10 in Section III of PA-40 Schedule SP. When determining the amount of annualized income, the total Eligibility Income on the prior year’s return may be used if the individual was eligible for Tax Forgiveness, received approximately the same income during this taxable year and did not have any transactions that were different from the previous tax year. The department will usually accept a rea­ sonable calculation of the decedent’s annual Eligibility In­ come. EXAMPLE: Jerry and Pat have been married for 50 years and Jerry dies on October 1 of the most recent tax year. Pat elects to file a joint return with her deceased spouse. Jerry worked as a custodian for a local school to supplement their social security income and died while still employed. Jerry and Pat also had joint interest and dividend income during the tax year. Jerry’s compensation income must be annual­ ized and the amount Jerry might have earned for the re­ maining three months of the tax year must be included on Line 2 in Section III of PA-40 Schedule SP. Because Pat is electing to file a joint return, the interest and dividend income from the joint ownership of the assets is not required to be annualized. If the surviving spouse (Pat) or Jerry’s estate elects to file a separate return, Jerry’s return would need to include annualized income from the interest and dividend classes of income in addition to the annualized compensa­ tion income. IMPORTANT: Surviving spouses should not include any income in respect of a decedent, income that should be included on the estate tax return, or any income of the deceased taxpayer (including the decedent’s half of any joint income received prior to the decedent’s date of death) in the taxable income or in the calculation of the Eli­ gibility Income of the surviving spouse when a separate re­ turn is filed by the surviving spouse.

DEPENDENT CHILDREN A dependent child for PA-40 Schedule SP purposes is a minor or adult child claimed as a dependent on a federal in­ come tax return. NOTE: If there are no dependents, go to Section III of PA-40 Schedule SP. The Department of Revenue has a two-step test for a de­ pendent child: 1. Is the individual a child of the claimant? For Pennsylvania income tax purposes, a child includes the natural child, adopted child, or step-child of a parent. Child also includes a grandchild of a grandparent and a foster child of a foster parent. Therefore, a son or daughter, a grandchild, or a foster child can be claimed as a dependent for PA-40 Schedule SP if the child is claimed as a dependent on the federal income tax re­ turn of the taxpayer. However, an aunt, uncle, or unre­ lated person cannot claim a child as a dependent, as defined above, even if claiming the child as a dependent on a federal income tax return. 2. Can the claimant claim the child as a dependent for federal tax purposes? The age, status as a full-time student, and gross income of a daughter, son, granddaughter, grandson, or foster child are factors only in determining whether the claimant can claim the child as a dependent for federal purposes. For example, parents that can claim a qualifying 30-year- old child for federal purposes can claim that child as a dependent for PA-40 Schedule SP purposes. A dependent child cannot be claimed on PA-40 Schedule SP if: ● The dependent is not a child of the taxpayer, as defined above; LINE 4 SECTION II NEXT PAGE PREVIOUS PAGE

PA-40 SP 4 www.revenue.pa.gov ● The child cannot be claimed on the federal tax return of the taxpayer; ● The taxpayer is unmarried for Tax Forgiveness pur­ poses, and the former spouse by agreement or court decree can claim the child as a dependent for federal and PA-40 Schedule SP purposes; or ● The child’s other parent, by agreement or court decree, can claim the child as a dependent for federal tax and Pennsylvania Tax Forgiveness purposes. Taxpayers filing PA Schedule SP for the first time, or claiming a new dependent on PA Schedule SP for the first time on a return where Tax Forgiveness is claimed, should include copies of the birth certificates and Social Se­ curity cards of all the dependents listed on PA Schedule SP, Section II. For taxpayers with more than four dependent chil­ dren, the department recommends that all the children in­ cluded as dependents on PA Schedule SP, Section II, also be included as dependents for federal income tax purposes even if no tax benefit for federal tax purposes results from including them as dependents on the federal return. No other adult can be claimed as a dependent, even if doing so on a federal tax return. A dependent child with taxable income in excess of $33 must file a PA-40, Personal Income Tax Return. If that child’s parents qualify for Tax Forgiveness, that child is also eligible for this credit. The child must file a tax return and a PA-40 Schedule SP. The child must also include any child support paid to his/her parent on his/her behalf in his/her Eligibility Income.

Enter the name, age, relationship to the taxpayer and SSN for each dependent in the spaces provided. If there are more than nine dependents, include a statement showing the name, age relationship and SSN of each dependent.

Enter the total number of dependent children claimed. CAUTION: If an adult child, an adopted child, a foster child, or a child with a different last name from the taxpayer is claimed on PA-40 Schedule SP, a copy of pages one and two of the federal income tax return for the tax year must also be included.

ELIGIBILITY INCOME Use Column A if unmarried or married filing jointly. Use the columns under Column B and C if married filing separately.

Enter the total PA Taxable Income amount from Line 9 of the PA-40, Personal Income Tax Return. LINE 1 LINE 2 SECTION III LINE 1 ELIGIBILITY INCOME TABLE 1. Unmarried, Separated and Deceased Claimants If the Eligibility Income from PA Schedule SP, Line 11, does not exceed: YOU ➡ $6,500 $6,750 $7,000 $7,250 $7,500 $7,750 $8,000 $8,250 $8,500 $8,750 ▼ DEPENDENT CHILDREN 1 $16,000 $16,250 $16,500 $16,750 $17,000 $17,250 $17,500 $17,750 $18,000 $18,250 2 $25,500 $25,750 $26,000 $26,250 $26,500 $26,750 $27,000 $27,250 $27,500 $27,750 3 $35,000 $35,250 $35,500 $35,750 $36,000 $36,250 $36,500 $36,750 $37,000 $37,250 4 $44,500 $44,750 $45,000 $45,250 $45,500 $45,750 $46,000 $46,250 $46,500 $46,750 5 $54,000 $54,250 $54,500 $54,750 $55,000 $55,250 $55,500 $55,750 $56,000 $56,250 6 $63,500 $63,750 $64,000 $64,250 $64,500 $64,750 $65,000 $65,250 $65,500 $65,750 7 $73,000 $73,250 $73,500 $73,750 $74,000 $74,250 $74,500 $74,750 $75,000 $75,250 8 $82,500 $82,750 $83,000 $83,250 $83,500 $83,750 $84,000 $84,250 $84,500 $84,750 9 $92,000 $92,250 $92,500 $92,750 $93,000 $93,250 $93,500 $93,750 $94,000 $94,250 Then the Percentage of Tax Forgiveness and the Decimal Equivalent is: 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1.0 .90 .80 .70 .60 .50 .40 .30 .20 .10 ELIGIBILITY INCOME TABLE 2. Married Claimants, even if filing separately If the Eligibility Income from PA Schedule SP, Line 11, does not exceed: YOU & ➡ SPOUSE $13,000 $13,250 $13,500 $13,750 $14,000 $14,250 $14,500 $14,750 $15,000 $15,250 ▼ DEPENDENT CHILDREN 1 $22,500 $22,750 $23,000 $23,250 $23,500 $23,750 $24,000 $24,250 $24,500 $24,750 2 $32,000 $32,250 $32,500 $32,750 $33,000 $33,250 $33,500 $33,750 $34,000 $34,250 3 $41,500 $41,750 $42,000 $42,250 $42,500 $42,750 $43,000 $43,250 $43,500 $43,750 4 $51,000 $51,250 $51,500 $51,750 $52,000 $52,250 $52,500 $52,750 $53,000 $53,250 5 $60,500 $60,750 $61,000 $61,250 $61,500 $61,750 $62,000 $62,250 $62,500 $62,750 6 $70,000 $70,250 $70,500 $70,750 $71,000 $71,250 $71,500 $71,750 $72,000 $72,250 7 $79,500 $79,750 $80,000 $80,250 $80,500 $80,750 $81,000 $81,250 $81,500 $81,750 8 $89,000 $89,250 $89,500 $89,750 $90,000 $90,250 $90,500 $90,750 $91,000 $91,250 9 $98,500 $98,750 $99,000 $99,250 $99,500 $99,750 $100,000 $100,250 $100,500 $100,750 Then the Percentage of Tax Forgiveness and the Decimal Equivalent is: 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1.0 .90 .80 .70 .60 .50 .40 .30 .20 .10 NOTE: If claiming more than nine (9) dependent children, go to the PA Personal Income Tax Guide – Tax Forgiveness on the department's website. NEXT PAGE PREVIOUS PAGE

PA-40 SP 5 www.revenue.pa.gov NONTAXABLE INCOME On Lines 2 through 10 of PA-40 Schedule SP, income must be reported that is not reported as taxable on the PA-40, Personal Income Tax Return, which PA law requires to be reported for Tax Forgiveness purposes. If no amounts are required to be reported on Lines 2 through 10, enter zero. Annualized income from each of the sources for Lines 2 through 10 should be reported for decedents on the respec­ tive lines.

Enter the amount of tax-exempt interest from Lines 6 and 7 of PA-40 Schedule A and any exempt-interest dividends in­ cluded in Line 3 of PA-40 Schedule B as well as any exempt income and gains from investments in direct obligations of the federal government, Pennsylvania, and political subdi­ visions of Pennsylvania. Include the nontaxable portion of gain from the sale of any property. Include nontaxable in­ come received as a beneficiary of an estate or trust as well as any tax-exempt income from a partnership or S corpora­ tion’s participation in a Keystone Opportunity Zone. For decedents only: in addition to any annualized income for nontaxable interest, dividends, and gains, include the differ­ ence between the total annualized income and the Pennsyl­ vania-taxable income from Line 1 above as well as any annualized tax-exempt interest or exempt-interest divi­ dends.

Enter the amount of alimony received by the taxpayer and/or spouse. Do not include child support payments re­ ceived by a spouse.

Enter the amount of the total proceeds received from life or other insurance policies. Also, include inherited cash or the value of property received as well as the amount received as reported on federal Form 1099-R with distribution code 4 reported in Box 7 of the form.

Enter the total amount of nontaxable cash or property re­ ceived as gifts from others. Also, include awards received in recognition of civic and social achievements and noncash prizes from the Pennsylvania Lottery.

Part-year residents and nonresidents must complete this line. Enter the total of all income, not already reported on this schedule, earned, received, or realized while residing outside Pennsylvania by the taxpayer and/or spouse. In­ clude any amount exempted from taxation under the Servicemembers Civil Relief Act. Part-year residents or non­ residents who file a paper copy of the PA-40, Personal In­ come Tax Return, must also include a copy of pages one and two of their federal income tax return.

Enter the amount that represents the difference between the total military income earned and the amount reported as tax­ able compensation on Line 1 of the PA-40 Personal Income Tax Return. Do not include combat zone pay and hazardous duty pay.

Enter the nontaxable gain from the sale of a principle resi­ dence.

Enter the amount of the total value of all nontaxable schol­ arships, fellowships, and stipends as well as the amount of any federal and state educational grants received. Do not include student loans. Also, include the value of tuition re­ ductions offered as part of an employer’s benefit plan.

Enter on Line 10 the following kinds of nontaxable income when determining Eligibility Income: ● Support received from a spouse or former spouse who does not live in the household. Do not include payments received for child support here – see the instructions for Section II. ● Any payments received from other persons outside the household, including nontaxable cash or property re­ ceived for personal use, such as cash received from a parent to buy clothing, or gifts from grown children. Do not include monies paid pursuant to a cost-sharing arrangement. ● Nontaxable payments to an employer’s cafeteria plan for hospitalization, sickness, disability, or death, sup­ plemental unemployment, or strike benefits. ● Payments received as a foster parent for providing in-home care for foster children. If claiming a foster child in Section II, the payments re­ ceived as a foster parent must be included. However, if the foster care program did not place the child in the home, or no payments were received for providing foster care, sub­ mit a written explanation that there is no income to report as a foster parent. Include an explanation of the child’s rela­ tionship to the taxpayer. ● The value of the personal use of employer-owned or leased property (if included in federal taxable income). ● The value of government education grants. Do not include the following types of nontaxable income in Line 10 when calculating Eligibility Income: ● Social Security and Railroad Retirement Benefits; ● Retirement benefits from Pennsylvania eligible retire­ ment plans after becoming eligible to retire and retiring; ● United Mineworkers pensions; ● Child support (unless a dependent child of a taxpayer also eligible for Tax Forgiveness); ● Military pension benefits; LINE 2 LINE 3 LINE 4 LINE 5 LINE 6 LINE 7 LINE 8 LINE 9 LINE 10 NEXT PAGE PREVIOUS PAGE

PA-40 SP 6 www.revenue.pa.gov ● Civil Service annuity payments; ● Payments received under workers’ compensation acts, occupational disease acts or similar legislation including Heart and Lung Pensions; ● Payment for injuries received while working and dam­ ages received, whether by suit or otherwise, for per­ sonal injuries; ● Sick pay and disability benefits, including payments by third party insurers for sickness and disability; ● Damage awards and settlements from physical injury or sickness – pain and suffering, emotional distress; ● Personal use of an employer’s owned or leased prop­ erty and/ or services, at no cost or at a reduced cost (if not included in federal taxable income); or ● Income from contracts of insurance for long-term care that do not have accumulated refundable reserves payable upon lapse or surrender.

Add Lines 1 through 10, and enter the total. If using Columns B and C, add each column, and enter the total on Line 11. Eligibility Income is the total amount of Pennsylvania-taxable and nontaxable income that is used to determine the percentage of Tax Forgiveness.

CALCULATING TAX FORGIVENESS

Enter the amount of the PA tax liability from Line 12 of the PA-40, Personal Income Tax Return. If filing an amended return, enter the amount from Line 12 of the amended PA- 40.

Enter the amount of any resident credit claimed on Line 22 of the PA-40, Personal Income Tax Return.

Subtract Line 13 from Line 12 and enter the result.

Find the Tax Forgiveness percentage and decimal equiva­ lent using the dependents from Section II, Line 2, the Eligi­ bility Income from Section III, Line 11, and the appropriate Eligibility Income Table below. Enter the decimal equivalent on Line 15.

Multiply Line 14 by the decimal on Line 15. Enter the product here and on Line 21 of the PA-40, Personal Income Tax Return. LINE 11 LINE 12 LINE 13 LINE 14 LINE 15 LINE 16 SECTION IV PREVIOUS PAGE RETURN TO FORM