Annual Reconciliation Of Employee Earnings Tax Form October 2004
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1MAKE NO MARKS IN THIS AREA
DUE DATE: APRIL 15, 2005
CITY OF PHILADELPHIA
2004 ANNUAL RECONCILIATION
6004
OF EMPLOYEE EARNINGS TAX
SOCIAL SECURITY NUM BER
TAXPAYER NAME & ADDRESS
Do not file this return if Philadelphia wage tax was
withheld on all compensation (Line 8 = Line 9).
File a Change Form to cancel this account.
If this is an amended return, check here:
1. Gross Compensation received. Enclose 2004 W-2 f orm(s).......................... ............... ....................1.
.00
2. Non-taxable compensation from Page 2, Line 3.... ............... ............... .............................. ............... 2.
.00
3. Net taxable compensation (Line 1 minus Line 2).................. ............... .............................. ...............3.
.00
4. Taxable Compensation received by a resident of Philadelphia in 2004....................... ............... 4.
.00
5. Tax Due (Line 4 X .044625).......................... ............... ............... ............... ............... ............... ........5.
.00
6. Taxable Compensation received by a non-resident of Philadelphia in 2004..................... .........6.
.00
7. Tax Due (Line 6 X .038801).......................... ............... ............... ............... ............... ............... ........7.
.00
8. Total Tax Due (Add lines 5 and 7)....................... ............... .............................. ............... ............... .8.
.00
9. A ny Philadelphia w age tax withheld by employer per enclosed W-2 forms................. ......................9.
.00
If line 8 is equal to line 9, STOP HERE! Do not file this return.
10. Net Tax Due (Line 8 less Line 9)................. ............... ............... ............... ............... ............... ......10.
.00
11. Tax not included on W-2 forms that you, not your employer, previously paid for 2004................. .11.
.00
12. ADDITIONAL TAX DUE If Line 10 is greater than Line 11, enter the difference here................ ..12.
.00
13. If Line 10 is less than Line 11, enter the OVERPAYM ENT to be:
.00
A . Ref unded.
Do not file a separate Re fund Petition.................... ............... ............... .........13A.
OR
.00
B. A pplied to the 2005 Earnings Tax............................. ............... ............... ............... ............... 13B.
If wage tax was overwithheld by your employer, do not file this return. File the Employee Wage Tax Refund Petition.
If claiming a refund on line 13, W-2 forms must accompany this return.
The Change Form and Refund Petition can be downloaded from
Under penalties of perjury, as set forth in 18 Pa. C.S . §§ 4902-4903 as amended, I swear that I have reviewed this return and
accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.
Taxpayer Signature_______________________________________ Date________________ Phone #____________________
Preparer Signature________________________________________ Date________________ Phone #____________________
EARN NACTP 10/23/2004
Page 1
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