Earned Income Tax Return Form - Palmer Township Eit Office
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1,
TAX OFFICE COPY
Palmer Township EIT Office
3
Weller Place
P.O.
Box
3039
Palmer,
PA
18043-3039
(610) 253-7191
Fax
(610) 253-9957
Earned Income Tax Return
NAME AND COMPLETE ADDRESS
Year
File this return on or before April 15th
Make checks payable to:
Palmer
% ~ V E S F ~ P ~
E!TO
BoroughTTownship:
If you moved into or out of a Pennsylvania taxing district you must file a form with each district for the time spentin each. Please comptete:
From
I
I
Present Address:
BoroTTwp.
TO
- I p p
1
From
- 1
- I -
Former Address:
BoroTTwp.
To
- I
- 1 -
Staple W-2
If you had NO EARNED INCOME, circle the reason, sign and return.
here, Schedule
Disabled
Homemaker
Unemployed
Retired
on back side
Deceased
Student*
hi?ili:epr
'All income regardless how minimal must be reported
Name
social Security #
Name
social Security
#
1.
Gross Earned Income
(Use b3x
18. if
blank use
16.
NY ivages
you must use box 5 j
2.
Less: Employee Business Expense (attach PA Schedule UE)
(If not attached, you will be billed the amount of deduction)
3.
Net Losses (attach PA Schedule C, F; or RK-1)(NO S-CORP)
4.
Line
1
less Lines
2 & 3 (Not less than zero)
5.
Net Losses: (attach PA Schedule C,
F; or RK-1)(NO S-CORP)
6.
Total of Lines
4 & 5
7.
Tax (1
% of Line 6)
8.
Local
1%
tax withheld by employers (Box
19)
9.
Quarterly payments andlor prior year credits
excludes
NJ
see line
10
10. Credit for taxes paid to other states
(
.
~nslruclinns an back!
11.
Total of Lines
8, 9, & 10
12. If line 7 is larger than Line 11, enter balance due
13. Penalty and interest of
1 %
per month (if not paid by April
15th)
14. Penalty for failure to file estimates
(8% of Line 12)
15. a. Late fee of
$1 0.00
if filed after April 15th.
b.
Late fee of
$1 0.00
per quarter for failure to file estimates.
16.
Total of Lines
12, 13, 14, & 15
Amount Due
1 3
1 4
15
1 6
Make checks payable to: Palmer ElTO
Payments of $.99 or less
are not required, nor will be refunded.
Omit payment if less than $1
17. If Line
11
is greater than Line
7,
enter overpayment option
Refund
Note: No refunds will be issued unless all supporting
Credit
documents are attached.
No refunds or credits of less than
$1
Under penalties of perjury I declare that
I
have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and
complete.
Occupation:
Occupation:
Phone #:
Date:
Preparer:
Address:
Phone:
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