Form 214 - Earned Income Tax Return - 2009
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42009
YORK ADAMS TAX BUREAU
YORK ADAMS TAX BUREAU
FORM 214
900 Biglerville Rd., PO Box 4374
1405 N. Duke St., PO Box 15627
EARNED INCOME TAX RETURN
Gettysburg, PA 17325
York, PA 17405-0156
BUREAU COPY
Complete and Return by April 15, 2010
Phone (717) 334-4000
Phone (717) 845-1584
Ê
SECTION
COMPLETE THIS SECTION ONLY IF YOU MOVED DURING 2009 AND ACCOUNT FOR ALL 12 MONTHS
A
# OF
BUREAU
B
TIME PERIOD
MONTHS
CODE
RESIDENT ADDRESS - INCLUDE CITY, STATE AND ZIP CODE
/
/
/
/ 09
09
A
TO
0
/
/
/
/
09
09
0
A
TO
/
/
/
/
09
TO
09
A
0
/
/
/
/
09
09
TO
0
A
CITY/BOROUGH/TOWNSHIP
BUREAU
SCHOOL DISTRICT
WHERE YOU PRESENTLY RESIDE
CODE
Click Here To Clear This Form
... please select your municipality
(enter name of taxpayer A here)
(enter name of taxpayer B here)
SSN
A
YOU MUST
COMPLETE
SSN
B
FOLD
A
B
TAXPAYER
TAXPAYER
PLEASE READ THE INSTRUCTIONS
BEFORE COMPLETING THIS RETURN
Ë
SECTION
1
0.00
0.00
1. W-2 Earnings.
(ENCLOSE A W-2 FORM FOR EACH EMPLOYER)
. . . . . . . . .
2
0.00
0.00
2. Employee business expenses.
(Enclose PA Schedule UE)
. . . . . . . . . . . . . . . .
3
0.00
0.00
(
)
Do not include interest, dividends or capital gains.
3. Other taxable earned income.
. . . .
Complete Section on back.
4
0.00
0.00
4. Total taxable earned income.
(Not less than zero.)
. . . . . . . . . . . . . . . . . . . . . . .
5. Net profit from Business, Farm, or Profession
(
)
5
0.00
0.00
ENCLOSE ALL PA SCHEDULES C, F,
*Report S Corp. income on reverse side only.
. . .
RK-1, NRK-1
6. Net loss from Business, Farm, or Profession
(
)
6
0.00
0.00
ENCLOSE ALL PA SCHEDULES C, F,
*Report S Corp. loss on reverse side only.
. . . . . .
RK-1, NRK-1
7
0.00
0.00
7. Total taxable net profit.
(Subtract line 6 from line 5. If line 7 is less than zero, enter zero)
. .
8
0.00
0.00
8. Total taxable earned income and net profit.
(Add lines 4 and 7.)
. . . . . . . . . . . . . . . . . . . . . . .
9. Total Tax Liability
USE APPLICABLE TAX RATE FROM TAX TABLE ON
9
0.00
0.00
INSTRUCTIONS OR TOTAL OF LINE 8 FROM SCHEDULE X OR SCHEDULE Z
.
10
0.00
0.00
10. Total local income tax withheld as per enclosed W-2’s. . . . . . . . . . . . . . . . . . . .
DO NOT INCLUDE PHILADELPHIA TAX
11
0.00
0.00
11. z 2009 quarterly tax payments, z plus 2008 tax overpayment transferred into 2009 tax year . .
FOLD
12
0.00
0.00
12. Credit for taxes paid to Philadelphia and/or other states. . . . . . . . . . . . . . . . . . . . . . . . .
13
0.00
0.00
13. Total credits.
(Add lines 10, 11, and 12)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
0.00
0.00
14. Overpayment/Refund.
(Line 13 minus line 9. If less than $1.00, enter zero)
. . .
15
0.00
0.00
15. Amount of overpayment to transfer to next year/transfer to spouse. oNext yr oSpouse
16
0.00
0.00
16. Tax Balance due.
(Line 9 minus line 13)
. . . . . . . . . . . .
IF LESS THAN $1.00 ENTER ZERO
17
0.00
0.00
17. Penalty after April 15.
(See instructions.)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
0.00
0.00
18. Interest after April 15.
(See instructions.)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INCLUDE PAYMENT VOUCHER
19
0.00
0.00
19. Total Amount Due (Add lines 16, 17, and 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INCLUDE CHECK PAYABLE TO Y.A.T.B.
I DECLARE UNDER PENALTIES PROVIDED BY LAW,
$
TOTAL DUE A+B
0.00
THAT THIS RETURN IS TRUE, COMPLETE AND CORRECT.
SIGNATURE-TAXPAYER
REQUIRED
DATE
OCCUPATION
EMAIL ADDRESS
DAYTIME TELEPHONE NO.
A
SIGNATURE-TAXPAYER
REQUIRED
DATE
OCCUPATION
EMAIL ADDRESS
DAYTIME TELEPHONE NO.
B
PAID PREPARER'S NAME, PLEASE PRINT
PAID PREPARER'S TELEPHONE NUMBER
A HUSBAND AND WIFE MAY BOTH FILE ON THIS FORM, HOWEVER, TAX
CALCULATIONS MUST BE REPORTED IN SEPARATE COLUMNS, JOINT
FILING (i.e. COMBINING INCOME, ETC.) IS NOT PERMITTED.
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