Form Clgs-32-1 - Taxpayer Annual Local Earned Income Tax Return - 2016 Page 2
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1
2TAXPAYER A:
S-CORPORATION PROFIT/LOSS REPORT
0 0
.
,
,
To avoid future correspondence, please report any S Corporation
TAXPAYER B
Pass-Through profits (losses) that were reported on your PA 40 Return.
0 0
.
,
,
LOCAL WORKSHEET (Moved During the Year)
PART YEAR RESIDENT
Residence #1 ____________________ Dates ________ to ________ Length of Time______________
Residence #2 ____________________ Dates ________ to ________ Length of Time______________
INCOME PRORATION ( _____________________________________________________________________ )
Residence # 1 COMPLETE ADDRESS
Employer # 1 ___________________
12
Local Income $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
12
Withholding $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Employer # 2 ___________________
12
Local Income
$ _______________ / ____________ X _______________________ = ________________
# of months at this residence
12
Withholding
$ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Residence #1
Total Income ____________________ Total Withholding ____________________
INCOME PRORATION ( _____________________________________________________________________ )
Residence # 2 COMPLETE ADDRESS
Employer # 1 ___________________
12
Local Income $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
12
Withholding $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Employer # 2 ___________________
12
Local Income
$ _______________ / ____________ X _______________________ = ________________
# of months at this residence
12
Withholding
$ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Residence #2
Total Income ____________________ Total Withholding ____________________
LINE 10: LOCAL EARNED INCOME TAX WITHHELD WORKSHEET
(Complete worksheet if you work in an area where the non-resident tax rate exceeds your home resident rate)
(1)
(2)
(5)
(3) Home Location
(4) Work Location
(6) Disallowed
(7) Credit Allowed
Local Wages
Tax Withheld
Resident Rate
Non-Resident Rate
Col 4 minus Col 3
Withholding Credit
For Tax Withheld
(W2 box 16 or 18)
(W2 box 19)
(See page 1, line 9)
(See Instructions)
(if less than 0 enter 0)
(Col 1 x Col 5)
(Col 2 - Col 6)
10,000
130
1.25%
1.30%
0.05%
5.00
125.00
Example:
1.
2.
3.
TOTAL - Enter this amount on Line 10
NON-RECIPROCAL STATE WORKSHEET
(See Instructions line 12)
EARNED INCOME: Taxed in other state as shown on the state tax return.
Enclose a copy of state return or credit will be disallowed ..........................................................................................................
(1)______________________
Local tax 1% or as specified on the front of this form ....................................................................................................................
X ______________________
(2)______________________
Tax Liability Paid to other state(s) ....................................................................................................
(3) ____________________
PA Income Tax (line 1 x PA Income Tax rate for year being reported) ............................................
(4) ____________________
CREDIT to be used against Local Tax
(Line 3 minus line 4) On line 12 enter this amount
or the amount on line 2 of worksheet, whichever is less. (If less than zero, enter zero) ........................................
(5) ____________________
**Additional Addresses:
DATES LIVING AT EACH ADDRESS
ADDRESS
TWP OR BORO
COUNTY
/
/
/
/
TO
/
/
/
/
TO
/
/
/
/
TO
A NOTE FOR RETIRED AND/OR SENIOR CITIZENS
IF YOU ARE RETIRED AND ARE NO LONGER RECEIVING A SALARY, WAGES OR INCOME FROM A BUSINESS, YOU MAY NOT OWE AN EARNED INCOME TAX.
SOCIALSECURITY PAYMENTS, PAYMENTS FROMAQUALIFIED PENSION PLANAND INTERESTAND/OR DIVIDENDSACCRUED FROM BANKACCOUNTSAND/OR
INVESTMENTS ARE NOT SUBJECT TO THE LOCAL EARNED INCOME TAX.
IF YOU RECEIVED A LOCAL EARNED INCOME TAX FORM AND ARE RETIRED WITH NO EARNED INCOME, PLEASE CHECK THE APPROPRIATE BOX ON THE
FORM AND RETURN.
IF YOU STILL RECEIVE WAGES FROM A PART-TIME EMPLOYER OR BUSINESS, YOU WILL NEED TO FILE AND PAY THE EARNED INCOME TAX.
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