Final Earned Income And Net Profits Tax Return - Southwest Regional Tax Bureau
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SOUTHWEST REGIONAL TAX BUREAU
Staple
FINAL EARNED INCOME AND NET PROFITS TAX RETURN *
Forms
Tax Year: _______________ Return Due Date: ____________
T S
T S
T S
Unemployed
Non-Resident
Part Year Resident
Dates
(Complete Address)
Retired
Deceased
T = Taxpayer
S = Spouse
__/__/____ to __/__/____
Please list all address that you
__/__/____ to __/__/____
lived at for this calendar year.
Current Name and Address
__/__/____ to __/__/____
ELECTRONIC FILING OPTION
GO TO
Taxpayer Name: _____________________________
Social Security Number: __________________
Spouse Name:
_____________________________
Social Security Number: __________________
SOUTHWEST REGIONAL TAX BUREAU
Return form, supporting
ONE CENTENNIAL WAY
Documentation & payments to:
SCOTTDALE, PA 15683
If you have questions call:
Phone: 724-887-5320
Web site:
Rates: 1.00% Resident Rate or 1.00% Non-Resident Rate
Office Hours:
8 a.m. – 4 p.m.
Two-income couples may each file separately on this form. However tax calculations must be entered in separate columns.
Taxpayers must provide verification of earned income/expense items as indicated on this return.
TAXPAYER
SPOUSE
1. Earned Income/Compensation, Gross Wages (Attach W-2, 1099 Misc. Forms.)
1.
2. Less Allowable Business Expenses (Attach PA UE Forms)
2.
3. TOTAL Earned Income & Compensation (Line 1 minus Line 2)
3.
4. Net Effect of Profits From Business, Profession, Farm, Schedule C, K, I, F
Loss = 0
4.
(Attach Documentation)
5. TOTAL Taxable Earned Income/Compensation & Net Profits (Line 3 plus Line 4)
5.
6. S_CORP (Non-Taxable) Schedule RK1
$
6.
7. Calculation of Tax – Multiply Line 5 by rates listed above.
7.
8. Tax Credits
8.
a. Tax Withheld by Employer (Box 19 from W-2 form)
a.
b. Quarterly Tax Payments
b.
c. Prior Year Overpayment
c.
d. TOTAL (Add Lines a, b, & c)
d.
9. Overpayment - Line 8d is greater than Line 7. ($1.00 or less will not be refunded or credited.)
9.
a. Refund (No Refund will be processed without complete documentation.)
a.
b. Credit to Next Year (No Credit will be processed without complete documentation.)
b.
10. Unpaid Tax Balance (If Line 8d is less than Line 7 enter amount due.)
10.
11. Penalty & Interest (1% per month of Line 10 if taxes are paid after April 15.
11.
(Additional charges will be assessed for failure to make proper quarterly tax payments.)
12. TOTAL Payment Due - Line 10 plus Line 11. ($1.00 or less not due.)
12.
13. If paying jointly, enter amount enclosed.
13.
(A payment due & a credit balance may be combined.)
SIGN YOUR RETURN. Under penalty of perjury I (we) have examined this form, and to the best of my (our) belief it is true, correct and
completed. THERE WILL BE A $10.00 FEE ADDED TO INTEREST AND PENALTY COST IF PAYMENT IS NOT ENCLOSED FOR THE AMOUNT
DUE ON OR BEFORE DUE DATE.
_________________________________________________________ _________________________________________________________
Taxpayer Signature
Date
Phone Number
Spouse Signature
Date
Phone Number
___________________________________________________________________________________________________________________
Preparer’s Name
Date
Phone Number
Signature of Preparer
*Filing this return does not constitute an appeal.
MAKE CHECKS PAYABLE TO – SOUTHWEST REGIONAL TAX BUREAU
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