Earned Income Tax Return Form Pennsylvania

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KEYSTONE TAX BUREAU
Station
Square
I, Suite 202 ·Paoli,
PA 19301
610-993-8609·
Fax 610-889-9427·
(See reverse for remittal
address)
Earned Income Tax Return
Year
File this return by April 15th even if no tax
is due or it has been withheld.
Make checks payable to "Springfield Township:'
Phone Number:
Boro/Twp.
_
Former address:
_
If you moved into or out of a Pennsylvania taxing district you must file a form with each district for the time spent in each. Please complete:
From
__
/ __
/ __
Present address:
Boro/Twp.
To
__
/ __
/ __
From
__
/ __
/ __
To
__
/_/_
Name
Name
Social Security
#
Social Security
#
1.
Gross
Earned
Income
(must
attach
W-2 or 1099)
2.
Less: Employee
Business
Expense
(must attach
PA
Schedule
UE
for
EIT
refund)
2
Note: Notrequired if PhilaWageTaxis youronlylocaltax withholding credit. Norefunds for PhilaTax.
3.
Net Losses
(must attach
PA Schedules
C, F, RK-1, or NRK-1)
3
5.
Net Profits
(must attach
PA Schedules
C, F, RK-1, or NRK-1)
4.
6.
Line 1 less Line 2
&
3 (Not less than zero)
Total of Lines 4
&
5
4
5
6
7.
Tax (1
%
of Line 6)
7
8.
Local Earned
Income
Tax withheld
by employers
(Usually
Box 19 of W-2)
8
9.
Estimated
tax payments
and carry over credit
9
10. Credit for tax paid to Phila. or other states
(seeinstructions)
10
(Credit a mt.is up to but not to
exceed 1.0%.
NOREFUNDS for Phila.or otherstates.)
11.
Total of Lines 8, 9,
&
10
11
12
13
14
15
Tax Due
Total Due
12. Line 7 minus
line 11. If $1 or more enter tax due
13. Penalty
and Interest of (1
%
per month of line 12) (Zero if filed by April 15th)
14. Delinquent
cost of $1 0 (Zero if filed by April 15th)
+ $10.00
per quarter for failure to pay quarterly
15. Total of lines 12, 13
&
14
(Make checks payable to: Springfield
Twp. or Keystone Tax Bureau)
Refund
16a
16. Line 11 minus Line 7. If $1 or more enter amount in Refund 16a or Credit 16b
Credit
16b
Do not round Tax amounts
All residents of Springfield Twp. must file even if tax is deducted/ or no Earned Income.
No refunds
or credits
of less than $1
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the
best of my knowledge and belief, it is true, correct, and complete.
Your Signature:
Spouse Signature:
Date:
_

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