Earned Income Tax Return Form Pennsylvania
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1
2KEYSTONE TAX BUREAU
P.O. BOX 441
SOUTHEASTERN,PA19399
610-993-8609 • Fax 610-889-9427 •
Earned Income Tax Return
Year
Filethisreturnby April 15thevenif no tax is due
or it has beenwithheld.
Makecheckspayable to
"CONSHOHOCKEN BOROUGH"
Phone Number:
BorofTwp.
_
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:
BorofTwp.
To
__
/ __
/ __
From
__
/ __
/ __
To
_/_/_
Name
Name
Social Security
#
Social Security
#
1.
Gross Earned Income (must attach W-2 or 1099)
1
2.
Less: Employee Business Expense
(must attach
PA
Schedule UE for refund of EIT)
2
Note: Not required if Phila Wage Tax is your only local tax withholding
credit. No refunds for Phila. Tax.
3.
Net Losses (must attach PA Schedules C, F, RK-1, or NRK-1)
3
4.
Line 1 less Line 2 & 3 (Not less than zero)
4
5.
Net Profits (must attach PA Schedules C, F, RK-1, or NRK-1)
5
6.
Total of Lines 4 & 5
6
7.
Tax 0.50% of Line 6 (Multiply line 6 by .0050)
7
8.
Local Earned Income Tax withheld by employers ( Usually Box 19 of W-2)
8
Must prorate at 0.50% (multiply by .50). No refunds for credits belonging to Colonial School District.
9.
Estimated tax payments and carry over credit
9
10. Credit for tax paid to Phila. or other states.
10
(Credit amI. is up to but not to exceed 0.50%. NO REFUNDS for Phila. or other states.)
11.
Total of Lines 8, 9, & 10
11
12. If Line 7 is larger than Line 11 enter balance due
13. Penalty and Interest of 1% per month (if not paid by April 15th)
14.
Total of Lines 12, 13
Amount Due
Make Checks payable to Conshohocken
Borough
12
13
14
Omit payment if less than $1
15. If Line 11 is larger than Line 7,
enter overpayment option
Refund
Credit
15
15
All residents of Conshohocken 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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