EVERY RESIDENT WITH TAXABLE INCOME MUST FILE THIS RETURN
RETURN FOR CALENDAR YEAR
BELLWOOD-ANTIS SCHOOL DISTRICT AND MUNICIPALITY INDIVIDUAL RETURN
THIS RETURN MUST BE FILED BETWEEN JANUARY 1 AND APRIL 15 FOLLOWING THE TAX YEAR
EARNINGS: JANUARY 1 - DECEMBER 31
WRITE ACTUAL AMOUNTS BELOW.
DO NOT MARK, “PAYROLL DEDUCTED.”
SEE REVERSE SIDE FOR INSTRUCTIONS
1.
a. EARNINGS FROM ALL W-2’s (Box 16) $
(ATTACH W-2’s)
b. BUSINESS EXPENSES
(ATTACH PA FORM UE)
$ (
)
IF ADDRESS IS INCORRECT PLEASE MAKE CORRECTION
c. NET BUSINESS LOSSES
IN SPACE BELOW:
(ATTACH PA SCH. C, F, K-1, ETC.)
$ (
)
DATE MOVED:
NEW ADDRESS:
d. NET BUSINESS INCOME
(ATTACH PA. SCH. C, F, K-1, ETC.)
$
NOTE: THE AMOUNT ON LINE 1c CANNOT
EXCEED THE SUM OF LINE 1a LESS 1b
e. TOTAL NET EARNINGS & PROFIT
(SUM OF 1a THROUGH 1d)
$
PLEASE FILL IN ALL PARTS BELOW
TAX (1% OF LINE 1e) TOTAL
$
2.
TWP/BORO IN WHICH YOU RESIDE
SOCIAL SECURITY #
3.
CREDITS FOR PAYMENTS
$
PHONE #
AMOUNT WITHHELD BY EMPLOYER
$
SINGLE:
MARRIED:
NAME OF SPOUSE:
4.
(Do Not include City of Altoona .2% Non-Resident tax)
5.
IF LINE 2 IS GREATER THAN TOTAL OF LINES
YOUR EMPLOYER’S NAME AND ADDRESS:
3 AND 4 - ENTER BALANCE DUE
$
(DISREGARD IF LESS THAN $1.)
6.
IF LINE 2 IS LESS THAN TOTAL OF LINES
TAXPAYER’S OCCUPATION
3 AND 4 - ENTER REFUND DUE
$
(DISREGARD IF LESS THAN $1.)
SEE REVERSE SIDE FOR FURTHER INSTRUCTIONS
MUNICIPAL SERVICE TAX (Occupational Privilege Tax)
7. TAX RATE
$ 10.00
This tax applies only to those persons who:
8. AMOUNT PAYROLL DEDUCTED $
(1) have the privilege to work within the Bellwood-Antis School
9. EXEMPTION
$
District, regardless of place of residence, and
10. AMOUNT DUE (subtract line 8 & 9
(2) have attained the age of (18) eighteen years.
from line 7)
$
(3) have earned $1000.00 or more.
FLAT RATE OCCUPATIONAL TAX
11. TAX RATE
$ 10.00
This tax is in addition to the occupational privilege tax and applies to
those persons who are residents of Bellwood-Antis School
12. EXEMPTION
$
District and have earned or made a profit of $2,500.00 or more as
13. AMOUNT DUE (subtract line 12
reported on line 1.
from line 11)
$
LATE PAYMENT PENALTY & INTEREST
14. INTEREST
$
All taxes remaining unpaid after they become due shall bear interest, in
addition to the amount of the unpaid tax, at the rate of six per centum
15. PENALTY
$
(6%) per annum, and a penalty of 1/2% of the amount of the unpaid tax
for each month or fraction of month.
16. LATE FILING FEE Add $2.00 after April
15th or add $5.00 after July 31st
MAKE CHECKS PAYABLE AND FORWARD TO
17. TOTAL REFUND OR AMOUNT DUE Add lines
5, 10, 13, 14, 15, 16, & minus line 6
$
BELLWOOD-ANTIS SCHOOL DISTRICT TAX OFFICE
400 MARTIN STREET
18. TOTAL AMOUNT PAID WITH THIS FORM $
BELLWOOD, PA 16617
Please donate my refund to the Bellwood-Antis School District Foundation
Website: tuckahoe.blwd.k12.pa.us
I
certify the above statement to be true and correct to my best
knowledge and belief.
X
X
DATE
SIGNATURE OF PREPARER
DATE
SIGNATURE OF TAXPAYER
THIS FORM MUST BE FILED EVEN IF YOU HAD NO EARNED INCOME OR NET PROFIT TO REPORT