Form F1 - Local Earned Income Tax Return - Pennsylvania
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1F1
08/05
LOCAL EARNED INCOME TAX RETURN
RESIDENT
JURISDICTION:
IF YOU MOVED during the tax year printed above, please complete below.
DATES LIVING AT EACH
ADDRESS
TWP OR BORO
COUNTY
ADDRESS
/
/
/
/
TO
/
/
/
/
TO
THIS RETURN MUST BE FILED BY APRIL 15 unless this is a Saturday or Sunday
then next business day. You are required to file whether tax is due, refund/credit
due, tax is withheld, OR YOU HAVE NO EARNED INCOME.
The calculations reported in the first column MUST pertain to the name printed in the
column, regardless of whether the husband or wife appears first.
Name
This is an INDIVIDUAL return. Combining income is NOT permitted.
Address
City
State
&
Zip
DO NOT STAPLE DOCUMENTATION TO FORM.
ENTER SPOUSE’S NAME
Home Phone
(please provide)
Enter Social Security #
Enter spouse’s Social Security #
Make any corrections to NAME, ADDRESS, SSN, or RESIDENT
JURISDICTION and check here. ADD IF NOT SHOWN.
If you had NO EARNED INCOME,
If you had NO EARNED INCOME,
check the reason why:
check the reason why:
disabled
student
disabled
student
deceased
military
deceased
military
homemaker
retired
homemaker
retired
unemployed
unemployed
.
.
,
,
,
,
1
Gross Earnings as Reported on W-2.
1.
Enclose W-2(s) with this form ................... 1
Allowable Non-reimbursed Employee Business Expenses.
2.
Include detailed
.
.
,
,
,
,
2
statement of expenses (See Instructions Line 2) ................................................................ 2
Taxable W-2 Earnings
3.
(Line 1 minus line 2) Audit may be required if all W-2’s and
.
.
,
,
,
,
3
supporting schedules are not enclosed ............................................................................... 3
.
.
,
,
,
,
4
Net Loss
4.
(Use line 6 for any Net profits) (See Instructions Line 4) ................................ 4
.
.
,
,
,
,
5
Subtotal
5.
(Line 3 minus 4) IF LESS THAN ZERO, ENTER ZERO .................................... 5
.
.
,
,
,
,
6
Net Profits
6.
(Use line 4 for Net losses) (See Instructions Line 6) ..................................... 6
NON-TAXABLE S-Corp earnings check this box:
.
.
,
,
,
,
7
Total Earned Income
7.
subject to this tax (Line 5 plus line 6) ........................................ 7
.
.
,
,
8
,
,
Tax Liability:
8.
Line 7 multiplied by tax rate of
................................... 8
.
.
,
,
,
,
9
Quarterly Estimated Payments.
9.
.............................................................................. 9
.
.
,
,
,
,
10
Earned Income Tax Withheld
10.
as per W-2 (See Instructions Line 10) ......................10
.
.
,
,
,
,
11
Credit from Last Year
11.
(If Credit Due) .......................................................................... 11
.
,
,
.
,
,
12
Miscellaneous Credits
12.
12
(i.e. Philadelphia Tax or Out-of-State Tax Credit - see instructions) ......
.
.
,
,
,
,
Total
13
13.
of 9 + 10 + 11 + 12 .................................................................................................. 13
REFUND/CREDIT
14.
(Line 13 minus line 8) IF $1.00 OR MORE, enter amount & check box below:
.
.
,
,
,
,
14
14
Credit to spouse
Credit to next year
Refund
.
.
,
TAX DUE
,
,
15.
(Line 8 minus line 13) OMIT IF LESS THAN $1.00 ........................................ 15
,
15
.
.
,
,
,
,
16
Interest & Penalties
16.
..................................................................................................... 16
.
.
TOTAL AMOUNT DUE
,
17.
(Line 15 + 16) Enter on line 17 and 18 .................................. 17
,
,
,
17
DATE
YOUR SIGNATURE
I declare under penalty of law that the information herein is correct.
DATE
R E C O R D EACH ACCOUNT TOTAL
SPOUSE’S SIGNATURE
DATE
ON LINES 17 & 18
PREPARED BY OTHER THAN TAXPAYER
DO NOT DETACH
RETURN ENTIRE NOTICE TO TAX OFFICE
.
.
18
18
,
,
,
,
Please write your social security number(s) on your check.
●
Remit entire notice to appropriate address, using return envelope provided.
●
If you pay in person, you MUST present this entire notice.
Include all required documentation with this form. Photocopies of W-2’s and
●
schedules ARE accepted. DO NOT STAPLE DOCUMENTATION TO FORM.
There will be a $20.00 fee for returned checks for insufficient funds.
●
AMOUNT OF
●
There may be a $12.50 fee if no check enclosed for tax due at time of filing.
ENCLOSED CHECK
To ensure proper credit to your account, please remit to the appropriate address.
19
To contact Berkheimer call
Website:
MAKE CHECK PAYABLE TO: HAB-EIT
Email:
50 N. Seventh Street
Bangor, PA 18013
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