Final Return For Earned Income Tax For The Year 2005 - Berks Earned Income Tax Bureau Form
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1
2Berks Earned Income Tax Bureau
Due Date:
2005
920 Van Reed Road, Wyomissing, PA 19610
April 17, 2006
Telephone: 610-372-8439 Fax: 610-372-1102
FINAL RETURN FOR EARNED INCOME TAX FOR THE YEAR 2005
SEE REVERSE SIDE OF THIS FORM AND SEPARATE INSTRUCTIONS & DEFINITIONS SHEET
Your social security number
Spouse's social security number
Office Use Only
Last Name
Your First Name & Middle Initial
Spouse's Last Name (If different from above)
If joint return, spouse's first name & middle initial
Physical Resident address (number and street)
City, State and Zip Code
If current address is different than above, please indicate new address:
New address:
Taxpayer/Joint
Office use only
1. Earned Income from W-2(s) (Both spouses) See instructions
(Enclose W-2(s) Indicating all information from Box 1 through Box 20)
1
2. Less: Allowable Unreimbursed employee business expenses (See instructions)
(Enclose PA UE and Page 1 of Form PA-40)
2
3. Other earned income (See instructions)
3
4. Losses from a business, farm, profession, partnership, etc.
(Enclose PA Schedules)
4
5. Sub-total (Line 1 minus Line 2 plus Line 3 minus Line 4 ) Not less than zero
5
6. Net profit from a business, farm, profession, partnership, etc.
6
(Enclose PA Schedules)
7. TOTAL TAXABLE EARNED INCOME (add Line 5 and Line 6)
7
8. Total Local Income Tax (1%) (Line 7 X .01)
** Union Township residents
See special rate instructions
8
9. Enter Total 1% Tax shown on W-2s** (Enclose W-2's - Copies ok)
9
10. 2005 ٱestimated payments, ڤplus Out-of-State tax credit, ڤplus Philadelphia tax credit
10
11. Add lines 9 and 10
11
TOTAL CREDITS
12. If Line 8 is larger than line 11, enter unpaid balance
DO NOT ROUND OFF
12
($20.00 service charge will be added to all returned checks)
13. If line 11 is larger than Line 8, enter refund due here (see instructions)
13
14. Interest and penalty (see instructions)
14
15. Pay balance due (line 12 plus line 14)
15
DO NOT ROUND OFF
Make Checks payable to "Berks EIT Bureau"
CHECK HERE IF PAYING BY CREDIT CARD
(see instructions for details)
TOTAL AMOUNTS OF LESS THAN $1.00 NEED NOT BE PAID, NOR WILL THEY BE REFUNDED
I DECLARE, UNDER PENALTIES PROVIDED BY LAW, THAT THIS RETURN HAS BEEN EXAMINED BY ME AND IS, TO THE BEST OF MY KNOWLEDGE,
A COMPLETE AND ACCURATE RETURN.
Your signature
Spouse's signature
Date
Your phone number
Tax Preparer's Signature
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