Final Individual Earned Income Tax Return Form Pennsylvania

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BOROUGH OF ALBURTIS
REFER TO INSTRUCTIONS
THIS IS NOT A JOINT RETURN,
Earned Income Tax Office
Below
FILE SEPARATELY
260 Franklin Street, PO Box 435
Alburtis, PA 18011-0435
(610) 966-4777
FINAL INDIVIDUAL EARNED INCOME TAX RETURN
:
NAME AND ADDRESS
OCCUPATION:
FILE THIS RETURN ON OR BEFORE APRIL 15,___________
SOCIAL SECURITY NO._________________TAX YEAR__________
If you moved into/out of the Borough during the tax year, complete below.
Date Moved:___________________________
____ IN ____OUT
DO NOT ROUND OFF FIGURES,
USE ACTUAL AMOUNTS
1. W-2 EARNINGS (wages, salaries, bonuses, commissions, etc. for local tax purposes):
Employer’ s Name and Local Address
Tax Withheld
W-2 Wages, etc.
a.
$
$
b.
$
$
c.
$
$
d.
$
$
TOTAL W-2 Wages, etc. for all employers (ATTACH W-2s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2. W-2 UNREIMBURSED BUSINESS EXPENSES (ATTACH PENNSYLVANIA SEHEDULE UE) . . . . . . . . . . . . . . . . . . . . . . . $
3. TAXABLE W-2 EARNINGS (line 1-line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
4. OTHER TAXABLE EARNED INCOME (ATTACH appropriate schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
5. TOTAL TAXABLE EARNED INCOME (line 3 + line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
6.
NET LOSS FROM BUSINESS, PROFESSION, OR OTHER ACTIVITY
(see instructions; use line 8 for net profits) (ATTACH Pennsylvania Schedules C, F, and RK-1) . . . . . . . . . . . . . . . . . . . . . . . . . $
7. Subtotal (line 5 – line 6) (IF LESS THAN ZERO, ENTER ZERO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
8.
NET PROFIT FROM BUSINESS, PROFESSION, OR OTHER ACTIVITY
(see instructions; use line 6 for net losses) (ATTACH Pennsylvania Schedule C, F, and RK-1) . . . . . . . . . . . . . . . . . . . . . . . . . . $
9. TOTAL TAXABLE INCOME (line 7 + line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
10. YOUR TAX (1% of line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
11. TAX WITHHELD (AS SHOWN ON line 1a, b, c, d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
12.
PAID BY QUARTERLY PAYMENTS OF ESTIMATED TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
13. OVERPAYMENT LAST YEAR CREDITED TO THIS YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
14. TOTAL CREDITS (line 11 + line 12 + line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
15. If line 10 is greater than line 14: BALANCE OF TAX DUE (LINE 10 – LINE 14) . . . . . . . . . . .DO NOT REMIT IF UNDER $1.00 $
16. After April 15, add INTEREST and PENALTIES (SEE INSTRUCTIONS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
17. TOTAL BALANCE DUE (line 15 + line 16) (Make check payable to “Borough of Alburtis”) . . . . . . . . . . . . . . . . . . . . . . . . . $
18. If line 14 is greater than line 10: OVERPAYMENT (line 14 – line 10) . . . . . . . . . . . .NO REFUNDS OR CREDITS UNDER $1.00 $
Check (X) if you want overpayment: ____ Refunded to you ____ Credited to next year’ s tax
TAXPAYER: I declare under the penalties of perjury that this return (including any accompanying schedules and statements) has been examined by me and to the best
of my knowledge and belief is a true, correct, and complete return.
Date:
Signature of Taxpayer:
PAID PREPARER: I declare under the penalties of perjury that I prepared this return for the person named herein, and that this return (including any accompanying
schedules and statements) is, to the best of my knowledge and belief a true, correct, and complete return based on all the information relating to the matters required to
be reported on which I have any knowledge.
Date:
Signature of Preparer:
Name or Company & Address:

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