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Type: Enter W-2 and 1099-R
Employer Name: Enter Name of employer
Employer Taxpayer ID: Enter employer’s taxpayer id
State: Enter employer’s state
State Wages: Enter total wages received
State Withholding: Enter amount of withholdings in box 17 on
W-2 or box 14 on 1099-R
Taxpayer or Spouse: Select the appropriate checkbox to identify
the W-2 or 1099-R as yours or your spouse’s
DE Schedule V – Delaware S Corporation Payments
Complete this schedule by listing all estimated Delaware tax payments
made by an S Corporation on behalf of you or your spouse. Use a separate
line for each S Corporation.
NOTE: If any of the schedules above are completed, Form PIT-RSS must
be sent in with your Delaware return.
SPECIAL FUNDS
Delaware’s Nongame Wildlife, Endangered Species and Natural
Areas Preservation Fund: Helping Delaware face the challenges of
managing and protecting native plants and animals, restoring wildlife
habitat, and maintaining the natural beauty of the state. Please give a
tax-deductible “Wild Gift” on Line 18A, Form PIT-RSS, Resident Schedule
III.
• Beau Biden Foundation: The foundation believes that child abuse
can be prevented through eectively educating adults and children,
developing the next generation of child welfare professionals, and
strengthening child protection laws around the country. Please help
by making a donation on line 18B, Form PIT-RSS, Resident Schedule III.
Please visit our website at www.beaubidenfoundation.org.
• Emergency Housing Assistance Fund: The homeless population
in Delaware continues to increase. Crisis situations such as
unemployment, family conicts, displacement, evictions, re, or utility
failures force people to seek emergency housing. You can help by
making a contribution on Line 18C, Form PIT-RSS, Resident Schedule III.
• Delaware Breast Cancer Education: Providing outreach, education
and support services throughout Delaware and the surrounding
communities to encourage the early detection and treatment of
breast cancer. Your contribution on Line 18D, Form PIT-RSS, Resident
Schedule III, will help the nearly 750 women facing breast cancer in
Delaware each year.
• Organ and Tissue Donation Awareness Trust Fund: One organ
and tissue donor can save or enhance the lives of 50 people. Make a
contribution on Line 18E, Form PIT-RSS, Resident Schedule III, to help
increase the number of organ and tissue donors in Delaware. Register
as an organ and tissue donor at www.donatelife-de.org.
• Delaware Diabetes Education Fund: Administered by the American
Diabetes Association (ADA), our mission is to prevent and cure
diabetes, and to improve the lives of those aected by diabetes. For
more information, please call 1-800-DIABETES or visit www.diabetes.
org. Help 85,000 Delawareans with diabetes by making a contribution
on Line 18F, Form PIT-RSS, Resident Schedule III.
• Delaware Veterens Home Fund: Show your support by making a
contribution on Line 18G, Form PIT-RSS, Resident Schedule III. Your tax
contribution will assist the Delaware Commission of Veterans Aairs in
maintaining a facility that provides much-needed services to our aging
veteran population. Please honor our heroes with a Veterans Home
contribution. Thank you for your support!
• Delaware National Guard And Reserve Emergency Assistance
Fund: Supporting members of the Delaware National Guard and
members of other Reserve Components (Army, Navy, Air Force,
Marine Corps, Coast Guard). Please show your support by making a
contribution on Line 18H, Form PIT-RSS, Resident Schedule III.
• Delaware Juvenile Diabetes Fund: The leading charitable funder
and advocate for research on type 1 diabetes, JDRF is associated with
major breakthroughs in type 1 diabetes research, such as the articial
pancreas, beta cell regeneration and the treatment of complications.
Your tax-deductible donation to JDRF may be made on Line 18I, Form
PIT-RSS, Resident Schedule III.
• Delaware Chapter Of The National Multiple Sclerosis Society:
Funding programs, services, and nancial assistance needed by
Delawareans with MS, plus important research into the cause of MS,
the development of more eective treatments, and eventually the
cure. Please help by making a contribution on Line 18J, Form PIT-RSS,
Resident Schedule III.
• Delaware Ovarian Cancer Foundation: Our mission is to increase
awareness and education, to facilitate research for an early detection
test, and to support women aected by ovarian cancer. Please show
your support by making a contribution on Line 18K, Form PIT-RSS,
Resident Schedule III.
• 21st Century Fund For Delaware’s Children, Inc.: Addressing the
needs of Delaware’s at-risk children under the age of 21 who are
receiving services from state agencies or community organizations.
Grants provide experiences to dene strengths, improve self-esteem,
and build hope for the future. Please help by contributing on Line 18L,
Form PIT-RSS, Resident Schedule III.
• White Clay Creek Wild And Scenic River Preservation Fund: Working
to improve water quality, conserve open space, woodlands, wetlands,
and geological features, protect rare native plant and animal species,
and aid in the preservation of cultural, historical, and archaeological
sites. Please help by making a contribution on Line 18M, Form PIT-RSS,
Resident Schedule III.
• The Home Of The Brave Foundation, Inc.: Established to furnish
food, shelter, and counseling to veterans of the Armed Forces of the
USA without regard to sex, race, color, or creed and provide positive,
supportive assistance to transition out of homelessness. Please help
by contributing on Line 18N, Form PIT-RSS, Resident Schedule III. For
more information, visit www.homeofthebravefdn.org.
• Senior Trust Fund: Administered by the Director of the Division of
Services for Aging and Adults with Physical Disabilities, to provide
assistance and programs for seniors and support the aging services of
community-based organizations. Please help by contributing on Line
18O, Form PIT-RSS, Resident Schedule III.
• Delaware Veterans Trust Fund: Provides nancial assistance to
eligible veterans, making a dierence for veterans who need assistance
with reintegration on their return home, those with disabilities awaiting
benets, or those who have met with a nancial hardship. Show your
support for veterans with a contribution on Line 18P, Form PIT-RSS,
Resident Schedule III.
• Protecting Delaware’s Children Fund: Supports an annual public
education campaign during Child Abuse Prevention and Awareness
Month, to educate the public about the signs of child abuse and the
duty to report. Your contribution on Line 18Q, Form PIT-RSS, Resident
Schedule III will make certain that the public knows and understands
their role in keeping children safe.
• Food Bank Of Delaware: Our mission is to provide nutritious foods
to Delawareans in need and facilitate long-term solutions to the
problems of hunger and poverty through community education and
advocacy. You can help by making a contribution on Line 18R, Form
PIT-RSS, Resident Schedule III.
• Delaware Habitat For Humanity: Habitat for Humanity organizations
in New Castle County, Kent County, and Sussex County bring people
together to build homes, communities, and hope. You can help by
making a contribution on Line 18S, Form PIT-RSS, Resident Schedule
III. Your contribution will be directed to the Habitat for Humanity in the
county in which you live.
• B+ Childhood Cancer: The B+ Foundation is helping kids ght cancer
by providing nancial and emotional support to families of children
with cancer nationwide. The B+ Foundation also funds critical, cutting-
edge childhood cancer research. For more information, please visit our
website at www.bepositive.org. You can help by making a contribution
on Line 18T, Form PIT-RSS, Resident Schedule III.
• Combined Campaign for Justice: The goal of Combined Campaign
for Justice is to help bridge the justice gap in Delaware and ensure civil
legal aid is available to poor and vulnerable people when it matters
most. There is a signicant justice gap in Delaware—more than eighty
percent of the civil legal needs of poor people are going unmet. You
can help by making a contribution on Line 18U, Form PIT-RSS, Resident
Schedule III.