Local Earned Income Tax Return - Lancaster County Tax Collection Bureau
ADVERTISEMENT
1
2THIS RETURN MUST BE FILED BY
LOCAL EARNED INCOME TAX RETURN
APRIL 15.
LANCASTER COUNTY TAX COLLECTION BUREAU
FOR OFFICIAL USE ONLY
A
Taxpayer A
Check all that apply:
Taxpayer B
Moved (Complete
Address
Section B and Schedule P)
Extension Request
Amended Return
City
State
If you had no Earned Income
check reason:
Zip Code
A
B
Disabled
Please Indicate:
Deceased
B
COMPLETE THIS SECTION IF YOU MOVED DURING THE TAX YEAR. ACCOUNT FOR ALL 12 MONTHS.
Homemaker
Unemployed
Address
From MM/DD/YYYY
To MM/DD/YYYY
Municipal Code (Table 1)
Student
Military
Retired
C
SELECT MUNICIPAL CODE FOR YOUR RESIDENCE ON
TA X PAY E R A
TA X PAY E R B
12/31 FROM TABLE 1 (See Instructions):
D
SOCIAL SECURITY NUMBER (Enter complete SS#)
D
1
W-2 EARNINGS
0 0
0 0
1
Enclose Supporting W-2’s
2
EMPLOYEE BUSINESS EXPENSE
0 0
0 0
2
Enclose Pennsylvania form PA - UE
3
OTHER TAXABLE EARNED INCOME
0 0
0 0
3
DO NOT include interest, dividends or capital gains
4
TOTAL TAXABLE EARNED INCOME
0 0
0 0
4
Line 1 minus Line 2 plus Line 3. If less than zero, enter zero
5
NET PROFIT(S)
0 0
0 0
5
Enclose Schedules/Report S Corp. income on reverse side only
6
NET LOSS(ES)
0 0
0 0
6
Enclose Schedules/Report S Corp. loss(es) on reverse side only
7
TOTAL TAXABLE NET PROFIT(S)
0 0
0 0
7
Line 5 minus Line 6. If less than zero, enter zero
8
TOTAL TAXABLE EARNED INCOME AND NET PROFIT
0 0
0 0
8
Line 4 plus Line 7
9
TAX LIABILITY
Line 8 multiplied by decimal tax rate __________.
0 0
0 0
9
See instructions
10
TOTAL LOCAL INCOME TAX WITHHELD
0 0
0 0
10
As indicated on enclosed W-2’s
11
ESTIMATED PAYMENTS and/or PRIOR YEAR CREDIT
0 0
0 0
11
APPLIED TO THIS TAX YEAR
12
CREDIT FOR TAXES
Worksheet on Reverse Side
0 0
0 0
12
PAID TO PHILADELPHIA and/or OTHER STATES
13
TOTAL CREDITS
0 0
0 0
13
Add Lines 10, 11, and 12
14
OVERPAYMENT/REFUND
0 0
0 0
14
Line 13 minus Line 9. If less than $2.00, enter zero
15
AMOUNT OF OVERPAYMENT TO
0 0
0 0
15
CREDIT TO NEXT YEAR/TRANSFER to/from SPOUSE
16
TAX BALANCE DUE
0 0
0 0
16
Line 9 minus Line 13, minus any credit from spouse. If less than $2.00, enter zero
17
PENALTY & FEES
0 0
0 0
17
Add 1% per month after April 15
18
INTEREST
0 0
0 0
18
See instructions
19
TOTAL AMOUNT DUE
0 0
0 0
19
Add Lines 16, 17 and 18
20
I / we declare under penalties provided by law that this return and all accompanying schedules and statements have been examined by me / us.
To the best of my / our knowledge and belief they are true, correct and complete.
PAID PREPARER’S NAME
Occupation
Signature A
Day Phone
Date
(PLEASE PRINT) & TELEPHONE:
Signature B
Day Phone
Date
Occupation
Signature
Day Phone
EARNED INCOME TAX PAYMENT VOUCHER
TA X PAY E R A
TA X PAY E R B
TAX YEAR
21
21
21
SSN
(from Line D)
22
22
22
TAX DUE
(from Line 16)
PENALTY &
23
Taxpayer A
23
23
FEES
(from Line 17)
24
24
24
INTEREST
(from Line 18)
Taxpayer B
25
25
TOTAL DUE
(from Line 19)
PO BOX 11444
submitted with your payment.
40105 00000000000 00000 00 00000000000 000000000 000000 00000000000 0
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial