Form Fr 1 - Final Individual Earned Income Tax Return - 2009
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1
2PARKLAND SCHOOL DISTRICT
TAX OFFICE COPY
FORM FR 1
REFER TO INSTRUCTIONS
EARNED INCOME TAX OFFICE
ON REVERSE SIDE
P.O. BOX 200 OREFIELD, PA
18
069-0200
2009
PHONE 610-351-5570
FOR CALENDAR YEAR
FINAL INDIVIDUAL EARNED INCOME TAX RETURN
(File this return with the Income Tax Officer On or before April 15, 2010.
Any balance of tax (ITEM 8) shall be paid in full with return.)
IF YOU HAVE MOVED WITHIN THE ABOVE YEAR, PLEASE COMPLETE THIS SECTION.
CURRENT ADDRESS __________________________________________________________________ DATE MOVED _______________________
FORMER ADDRESS ___________________________________________________________________ DATE MOVED _______________________
(PLEASE MAKE ANY NECESSARY CORRECTIONS)
◄
NAME
OCCUPATION
◄
ADDRESS
(1) ENTER YOUR GROSS EARNINGS AS REPORTED ON FORM W2(S)
RESIDENT TOWNSHIP
PRINT EMPLOYER’S NAME AND LOCAL ADDRESS
_________________________________________________
_ _ _ _ _ _ _
$
IF MORE SPACE
_________________________________________________
_ _ _ _ _ _ _
$
NEEDED PLEASE
ATTACH
_ _ _ _ _ _ _
SEPARATE SHEET
$
A COPY OF FORM W-2 AND/OR 1099 FOR EACH EMPLOYER MUST BE ATTACHED
_ _ _ _ _ _ _
(1A) LESS UNREIMBURSED EXPENSES, IF ANY, AS REPORTED ON
$
FORM PA UE
_ _ _ _ _ _ _
$
(1 B) ENTER TOTAL HERE
A COPY OF PA FORM UE MUST BE ATTACHED
(2) COMBINED NET PROFIT AND NET LOSS FROM BUSINESS OR PROFESSION
NOT LESS THAN ZERO
FROM
$_ _ _ _ _ _ _ _ _
FORM PA 40 SCHEDULE PA-C, F, OR RK-1
SEE REVERSE SIDE, ITEM B2, FOR INSTRUCTIONS
(3) TOTAL TAXABLE INCOME (ITEM 1B PLUS 2)
A COPY OF ALL SCHEDULES MUST BE ATTACHED
$_ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _
(4)
YOUR TAX (1% OF LINE 3)
$
(5)
AMOUNT PAID:
_ _ _ _ _ _
BY WITHHOLDING FROM YOUR WAGES
$
(A)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _
BY PAYMENTS ON YOUR ESTIMATED TAX
$
(B)
_ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _
BY PAYMENTS TO OTHER STATE OR POLITICAL SUBDIVISION
$
(C)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
SEE REVERSE SIDE, ITEM B6, FOR INSTRUCTIONS
_ _ _ _ _ _ _
$
(ITEM 5D) ENTER TOTAL OF 5A, 5B AND 5C HERE
_ _ _ _ _ _ _
OVERPAYMENT
(6)
$
IF YOUR PAYMENTS (ITEM 5D) ARE LARGER THAN YOUR TAX (ITEM 4) ENTER
HERE
CHECK (X) IF YOU WANT THIS OVERPAYMENT
OR CREDITED TO YOUR
2010
REFUNDED TO YOU
ESTIMATED TAX
_ _ _ _ _ _ _
BALANCE OF TAX DUE
(7
$
) IF YOUR TAX (ITEM 4) IS LARGER THAN (ITEM 5D) ENTER
HERE
_ _ _ _ _ _ _
(7A)
$
AFTER APRIL 15, ADD 1% INTEREST AND PENALTY CHARGES PER MONTH OF LINE 7
SEE REVERSE SIDE, B4, IF AN IRS EXTENSION HAS BEEN FILED.
MAKE CHECKS PAYABLE TO
_ _ _ _ _ _ _
“PARKLAND SCHOOL DISTRICT”
(8)
$
TOTAL PAYMENT DUE WITH THIS RETURN (LINE 7 PLUS LINE 7A)
I DECLARE, UNDER THE PENALTIES OF PERJURY, THAT THIS RETURN HAS BEEN PREPARED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF, IS A TRUE, CORRECT, AND COMPLETE FORM.
THIRD PARY
DO YOU WANT TO ALLOW ANOTHER PERSON TO DISCUSS THIS RETURN WITH THE PARKLAND TAX OFFICE
YES
NO
DESIGNEE
DESIGNESS’ NAME___________________________________________PHONE NO (________)__________________________
____________________________________________________________
__________________________________________________________________________
DATE
SIGNATURE OF TAXPAYER
PLEASE COMPLETE THE FOLLOWING IF PREPARED BY OTHER THAN TAXPAYER
____________________________________________________________
__________________________________________________________________________
DATE OF PREPARATION
NAME / COMPANY OF PREPARER
____________________________________________________________
__________________________________________________________________________
SIGNATURE OF PREPARER
ADDRESS
THIS FORM MUST BE FILED WHETHER YOUR TAX HAS BEEN WITHHELD OR NOT
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