2009 Final Earned Income Tax Return - Mt. Lebanon School District

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NO JOINT RETURNS
MT. LEBANON, PA.
PARTIAL YR. RESIDENTS
PERMITTED
MT. LEBANON SCHOOL DISTRICT
INDICATE DATES
2009 FINAL EARNED INCOME TAX RETURN - DUE 4/15/10
SEE ENCLOSED INSTRUCTIONS
MOVE IN __________ OR
MOVE OUT __________
CHANGE IN TAX STATUS:
DATE OF CHANGE:________________________________
_____
PERMANENTLY RETIRED
_____
PERMANENTLY DISABLED
_____
ACTIVE DUTY MILITARY
_____
MOVED - NEW ADDRESS____________________________________________
ACCOUNT#:
SS#:
TAX YEAR:
DUE DATE:
EMPLOYER:
NOTE: EFFECTIVE TAX YEAR
1. TOTAL EARNED INCOME AND COMPENSATION
1
2009 - BUSINESS LOSSES MAY
2. LESS ALLOWABLE EMPLOYEE BUSINESS EXPENSES
2
IF BUSINESS LOSS ENTER $0
3. TAXABLE NET PROFITS FROM BUSINESS-
NOT BE DEDUCTED AGAINST
3
COMPENSATION.
4. NON TAXABLE NET PROFITS/LOSSES $____________________
XXXXXXXXXXXXXXXXX
5. TOTAL EARNED INCOME AND NET PROFITS (1- 2 + 3)
5
MAKE CHECKS PAYABLE TO:
6. TAX DUE (MULTIPLY LINE 5 BY .013)
6
MT. LEBANON, PA.
7. TAX PAID AS OF
(INCLUDING CREDITS)
7
MAIL PAYMENTS TO:
8. OVERPAYMENT (CHOOSE ONE OF THE FOLLOWING
710 WASHINGTON ROAD
OPTIONS IF LINE 7 IS GREATER THAN LINE 6)
PITTSBURGH, PA. 15228
CHECK ONE: ____CREDIT ____DONATION ____REFUND
8
412-343-3405
9. TAX BALANCE (IF LINE 7 IS LESS THAN LINE 6)
9
FAX: 412-343-4560
10. PENALTY AND INTEREST DUE FOR LATE QUARTERLY PAYMENTS
10
11. PENALTY AND INTEREST DUE FOR LATE FINAL RETURN PAYMENTS
11
OFFICE HOURS:
12 TOTAL PAYMENT DUE (LINE 9 + 10 + 11)
12
8:30 AM TO 5:00 PM
I DECLARE UNDER PENALTIES PROVIDED BY LAW, THAT THIS RETURN WAS EXAMINED BY ME AND TO
MONDAY THROUGH FRIDAY
THE BEST OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN
SIGNATURE _____________________________________________________
DATE _______________
RETURN THIS PORTION TO THE MT. LEBANON TREASURER'S OFFICE
CUT HERE
CUT HERE
NAME:
ACCOUNT #:
NO JOINT RETURNS
MT. LEBANON, PA.
PARTIAL YR. RESIDENTS
PERMITTED
MT. LEBANON SCHOOL DISTRICT
INDICATE DATES
2009 FINAL EARNED INCOME TAX RETURN - DUE 4/15/10
SEE ENCLOSED INSTRUCTIONS
MOVE IN __________ OR
MOVE OUT __________
NOTE: EFFECTIVE TAX YEAR
1. TOTAL EARNED INCOME AND COMPENSATION
1
2009 - BUSINESS LOSSES MAY
2. LESS ALLOWABLE EMPLOYEE BUSINESS EXPENSES
2
IF BUSINESS LOSS ENTER $0
NOT BE DEDUCTED AGAINST
3. TAXABLE NET PROFITS FROM BUSINESS-
3
COMPENSATION.
4. NON TAXABLE NET PROFITS/LOSSES $____________________
XXXXXXXXXXXXXXXXX
5. TOTAL EARNED INCOME AND NET PROFITS (1- 2 + 3)
5
6. TAX DUE (MULTIPLY LINE 5 BY .013)
6
MAKE CHECKS PAYABLE TO:
7. TAX PAID AS OF
(INCLUDING CREDITS)
7
MT. LEBANON, PA.
8. OVERPAYMENT (CHOOSE ONE OF THE FOLLOWING
MAIL PAYMENTS TO:
OPTIONS IF LINE 7 IS GREATER THAN LINE 6)
710 WASHINGTON ROAD
CHECK ONE: ____CREDIT ____DONATION ____REFUND
8
PITTSBURGH, PA. 15228
9. TAX BALANCE (IF LINE 7 IS LESS THAN LINE 6)
9
412-343-3405
10. PENALTY AND INTEREST DUE FOR LATE QUARTERLY PAYMENTS
10
FAX: 412-343-4560
11. PENALTY AND INTEREST DUE FOR LATE FINAL RETURN PAYMENTS
11
12 TOTAL PAYMENT DUE (LINE 9 + 10 + 11)
12
TAXPAYER RECEIPT / RETAIN THIS PORTION

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