Annual Reconciliation Of 2009 Employee Earnings Tax - City Of Philadelphia
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1SOCIAL SECURITY NUMBER
CITY OF PHILADELPHIA
6
0
0
9
ANNUAL RECONCILIATION OF 2009
-
-
EMPLOYEE EARNINGS TAX
DUE DATE APRIL 15, 2010
Do not file this return if Philadelphia wage tax was
Print Taxpayer Name and Address
withheld on all compensation (Line 12 = Line 13).
File a Change Form to cancel this account.
If wage tax was overwithheld by your employer, do
not file this return. File the Employee Wage Tax
Refund Petition.
The Change Form and Employee Refund Petition
can be downloaded from
If this is an amended return place an "X" here:
YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF ADDRESS
OR TO CANCEL THIS ACCOUNT.
,
,
.00
1. Gross Compensation received in 2009. Enclose 2009 W-2 form(s)........................1.
,
,
.00
2. Non-taxable gross compensation from Page 2, Line 5.............................................2.
.00
,
,
3. Gross taxable compensation (Line 1 minus Line 2)..................................................3.
4. Taxable Gross Compensation received by a resident of Philadelphia
.00
,
,
January 1, 2009 to June 30, 2009...........................................................................4.
,
,
.00
5. Tax Due (Line 4 times .0393)....................................................................................5.
6. Taxable Gross Compensation received by a resident of Philadelphia
,
,
.00
July 1, 2009 to December 31, 2009.........................................................................6.
.00
,
,
7. Tax Due (Line 6 times .039296)................................................................................7.
8. Taxable Gross Compensation received by a nonresident of Philadelphia
.00
,
,
January 1, 2009 to June 30, 2009...........................................................................8.
.00
,
,
9. Tax Due (Line 8 times .035)......................................................................................9.
10. Taxable Gross Compensation received by a nonresident of Philadelphia
,
,
.00
July 1, 2009 to December 31, 2009......................................................................10.
,
,
.00
11. Tax Due (Line 10 times .034997)............................................................................11.
.00
,
,
12. Total Tax Due (Add Lines 5, 7, 9 and 11)...............................................................12.
.00
,
,
13. Any Philadelphia wage tax withheld by employer per enclosed W-2 forms............13.
If Line 12 is equal to Line 13, STOP HERE! Do not file this return.
,
,
.00
14. Net Tax Due (Line 12 minus Line 13).....................................................................14.
15. Tax that you, not your employer, previously paid for 2009.
,
,
.00
(Not included on W-2 forms).................................................................................. 15.
16. ADDITIONAL TAX DUE If Line 14 is greater than Line 15, enter here
.00
,
,
and in the Tax Due box of the Payment Coupon....................................................16.
OVERPAYMENT OPTIONS If Line 14 is less than Line 15, enter the amount to be:
.00
,
,
17A. REFUNDED. Do not file a separate Refund Petition.......................................17A.
OR
.00
,
,
17B. APPLIED, up to the tax due, to the 2010 Earnings Tax Return............................17B.
If claiming a refund on line 17A, W-2 forms must accompany this return. Do not file a separate Refund Petition.
Under penalties of perjury, as set forth in 18 PA C.S. §§ 4902-4903 as amended, I swear that I have reviewed this return
and accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.
Taxpayer Signature________________________________________ Date_______________________Phone #_________________________
Preparer Signature_________________________________________ Date_______________________Phone #_________________________
Page 1
6009 Internet 10-14-09 Final
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