Form F-1 - Taxpayer Annual Local Earned Income Tax Return
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4F-1
TAXPAYER ANNUAL LOCAL EARNED INCOME TAX RETURN
You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement,
refund and collection of local taxes by contacting your Tax Officer.
DCEDF1
PO Box 25130
Lehigh Valley, PA 18002-5130
F1
WEB
TAX YEAR
RESIDENT JURISDICTION:
STATE
DATES LIVINGAT EACHADDRESS
STREET ADDRESS (No PO Box, RD or RR)
CITY OR POST OFFICE
ZIP
/
/
/
/
TO
/
/
/
/
TO
**If you need additional space - please see back of form.
To file online, visit
Name
Address
City
State
&
Zip
FM
AMENDED RETURN
EXTENSION
internal)
(
ENTER TAXPAYER’S NAME
ENTER SPOUSE’S NAME
DAYTIME PHONE NUMBER
RESIDENT PSD CODE
Enter Social Security #
Enter spouse’s Social Security #
The calculations reported in the first column MUST pertain to the name printed in
the column, regardless of whether the husband or wife appears first.
Combining income is NOT permitted.
If you had NO EARNED INCOME,
If you had NO EARNED INCOME,
ONLY USE BLACK OR BLUE INK TO COMPLETE THIS FORM
check the reason why:
check the reason why:
There will be an additional cost assessed for returned payments.
disabled
student
disabled
student
There will be an additional cost assessed if no payment is enclosed for tax due at time of filing.
deceased
military
deceased
military
homemaker
retired
homemaker
retired
unemployed
unemployed
.
0 0
.
0 0
,
,
,
,
1. Gross Compensation as Reported on W-2(s). (
) .........................
Enclose W-2(s)
.
0 0
.
0 0
,
,
,
,
2. Unreimbursed Employee Business Expenses. (
) ...........
Enclose PA Schedule UE
.
0 0
.
0 0
,
,
,
,
3. Other Taxable Earned Income * ..........................................................................
.
0 0
.
0 0
,
,
,
,
4. Total Taxable Earned Income (Subtract Line 2 from Line 1 and add Line 3)....
.
.
0 0
0 0
,
,
,
,
5. Net Profit (
*) ......................................................................
Enclose PA Schedules
NON-TAXABLE S-Corp earnings check this box:
.
0 0
.
0 0
,
,
,
,
6. Net Loss (
*) ........................................................................
Enclose PA Schedules
.
0 0
.
0 0
,
,
,
,
7. Total Taxable Net Profit (
)......
Subtract Line 6 from Line 5. If less than zero, enter zero
.
0 0
.
0 0
,
,
,
,
8. Total Taxable Earned Income and Net Profit (
) .........................
Add Lines 4 and 7
.
.
0 0
0 0
,
,
,
,
9. Total Tax Liability (Line 8 multiplied by
)..........................
.
0 0
.
0 0
,
,
,
,
10. Total Local Earned Income Tax Withheld (
)*
MAY NOT EQUAL W-2 - SEE INSTRUCTIONS
.
0 0
.
0 0
,
,
,
,
11.Quarterly Estimated Payments/Credit From Previous Tax Year.........................
.
.
0 0
0 0
,
,
,
,
12. Out of State or Philadelphia credits* (include supporting documentation)…....
.
0 0
.
0 0
,
,
,
,
13. TOTAL PAYMENTS and CREDITS (Add lines 10 through 12) .....................
.
.
0 0
0 0
,
,
,
,
14. Refund IF MORE THAN $1.00, enter amount
(or select option in 15)
....................
.
0 0
.
0 0
If you calculate a refund due, you may be denied. Please see Line 10 instructions.
,
,
,
,
15. Credit Taxpayer/Spouse (
).........
Amount of Line 14 you want as a credit to your account
.
0 0
.
0 0
Credit to next year
Credit to spouse
,
,
,
,
16. EARNED INCOME TAX BALANCE DUE (Line 9 minus Line 13) ....................
.
0 0
.
0 0
,
,
,
,
17. Penalty after April 15* (Multiply line 16 by 0.01 x number of months late-or a fraction of)..
.
0 0
.
0 0
,
,
,
,
18. Interest after April 15* Multiply line 16 by 0.00246 x number of months late-or a fraction of)
.
0 0
.
0 0
,
,
,
,
19. TOTAL PAYMENT DUE (
) Payable to HAB-EIT .........
Add Lines 16, 17, and 18
*See Instructions
Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying schedules and statements
and to the best of my (our) belief, they are true, correct and complete.
YOUR SIGNATURE
SPOUSE’S SIGNATURE (If Filing Jointly)
DATE (MM/DD/YYYY)
PREPARER’S PRINTED NAME & SIGNATURE
PHONE NUMBER
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