Title:  PA State Tax Form PA-40 for 2012

Status	    Single	{ Single, Married/Joint, Married/Sep, Widow(er) }

L1a     29812.34	{Gross compensation.}
	21609.09	 {spouse}
		;
L1b         0	        { Unreimbursed employee business expenses.}
	    0	         {spouse}
		;
L2	   34.56	{ Interest Income. }
	   17.83
		;
L3	  143.65	{ Dividend Income. }
	   29.32
		;
L4	    0	;	{ Income or loss for business operations. }
L5	    0   ;	{ Net gain or loss from disposition of property. }
L6	    0   ;	{ Net gain or loss rents, royalties, patents, or copyrights. }
L7	    0   ;	{ Estate or Trust Income. }
L8	    0   ;	{ Gambling or lottery winnings. }
L10	    0.0 ;	{ Other Deductions. }

L13	    813.67	{ Total PA Tax withheld. }
	    724.12	 {spouse}
		;
L14	    0   ;	{ Credit from 2011 PA income tax return. }
L15	    0	;	{ 2012 Estimated Installment payments. }
L16	    0	;	{ 2012 Extension payment. }
L17	    0   ;	{ Non-resident tax withheld. }
L21	    0   ;	{ Tax Back/Tax Forgiveness Credit (Part D line 16 Sched SP). }
L22	    0   ;	{ Resident credit (Scheds G/RK-1). }
L23	    0   ;	{ Other credits (Sched OC). }
L25	    0   ;	{ Use Tax }
L27	    0   ;	{ Penalties and underpayment interest. }
