Final Individual Earned Income Tax Return - 2009
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1MUNICIPAL & SCHOOL INCOME TAX OFFICE
203 W THIRD ST WILLIAMSPORT PA 17701
PHONE 570-327-5500 EXT 3540 OR 3582
Fax 570-327-0650
FINAL INDIVIDUAL EARNED INCOME TAX RETURN
JOINT RETURNS NOT PERMITTED
PLEASE FILE THIS RETURN BY APRIL 15TH EVEN IF NO TAX IS DUE OR IT HAS ALL BEEN WITHHELD
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SOCIAL SECURITY NUMBER
ID#
If you moved during the year complete below
DATE
ADDRESS
01/01/09 - __/__/__
_____________________________________
__/__/__ - __/__/__
_____________________________________
__/__/__ - __/__/__
_____________________________________
COMPLETE TAX RETURN AND WORKSHEET USING ONLY INCOME EARNED WHILE LYCOMING COUNTY RESIDENT
1. TOTAL W-2 EARNINGS--Tax deferrals cannot be deducted (Attach copy of W-2’s)...............1. ___________________
2. LESS: Allowable non-reimbursed employee expenses
ATTACH COPY OF PA STATE UE-1 OR UE-2 AND FORM 2106
...............2. _________________
3. TAXABLE W-2 EARNINGS (Subtract line 2 from 1).............................................3. ___________________
4. OTHER TAXABLE EARNED INCOME-Attach Form 1099
DO NOT INCLUDE INTEREST, DIVIDENDS, 1099G or 1099B.........................................4. ___________________
5. TOTAL TAXABLE EARNED INCOME (Add lines 3 and 4)...........................................5. ___________________
6. NET PROFITS (Pennsylvania schedules must be attached)
Sch. C__________ Sch. F__________ Sch. K-1____________............6.__________________
7. NET LOSSES (Pennsylvania schedules must be attached)
Sch. C__________ Sch. F__________ Sch. K-1___________.............7.__________________
8. SUBTOTAL (Subtract line 7 from line 6) If less than zero, enter zero......................8. ___________________
9. TOTAL TAXABLE INCOME (Add lines 5 and 8)..................................................9. ___________________
10. TOTAL EARNED INCOME TAX DUE (see instructions).....................10.__________________
11. CREDITS: a. Earned Income Tax withheld $__________
b. Tax payments on estimates
$__________ TOTAL CREDITS...11.__________________
12. If your credits (line 11) are larger than your tax due (line 10) enter overpayment ......12. ___________________
_
_
CHECK ONE
|_| CREDIT
|_| REFUND
13. If your tax due (line 10) is larger than your credits (line 11) enter BALANCE DUE........13. ___________________
14. Interest and penalty (1% per month after due dates) ...................... ..............14. ___________________
15. TOTAL PAYMENT DUE WITH THIS RETURN (Add lines 13, and 14)................................16. ___________________
COMPLETE PAYMENT VOUCHER AND SEND ALONG WITH RETURN AND CHECK
Make checks payable to INCOME TAX OFFICER
I declare, under the penalties of perjury that this return has been reviewed by me, and to the best of my knowledge is a true,
correct and complete form.
____________________________________
_______________
_________________________________
___________________________
SIGNATURE OF TAXPAYER
DATE
CURRENT TOWNSHIP, CITY OR BORO
CURRENT OCCUPATION
____________________________________________________________________________________________________________________________
COMPARISON OF LOCAL AND STATE INCOME AMOUNTS
TAXPAYER
SPOUSE
JOINT
Line 1 Amount on Line 9 of Local Tax Return
Line 2 Amounts on Line 1c and 4 of PA 40
Line 3 Difference
IF LINE 2 IS GREATER THAN LINE 1 EXPLAIN BELOW OR ON BACK.
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