2004 School Income Tax Form - City Of Philadelphia
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1CITY OF PHILADELPHIA
MAKE NO MARKS IN THIS AREA
DUE DATE: APRIL 15, 2005
2004 SCHOOL INCOME TAX
4304
TAXPAYER NAME & ADDRESS
YOUR S OCIAL SECURITY NUM BER
SPOUSE'S SOCIAL SECURITY NUM BER
Check here if this is an amended
return................................. ..............
To request a cancelation of this account, use a Change Form available at Instructions for lines 1 through 15 are
on pages 2 and 3 of the instruction booklet.
If you were a partial year resident in 2004 refer to page 4, and enter dates of residency here:
to:
1. Net Taxable Dividends.................... ............... ............... ............... ............... ............... ............... 1.
.00
2. Taxable Interest............... .............................. ............... ............... ............... .............................. 2.
.00
3. "Subchapter S" Corporation (if loss, enter "0")............................................ ............... ............... 3.
.00
4. Limited Partnership Income (if loss, enter "0")..................... .............................. ............... .........4.
.00
5. Taxable Income received as a Beneficiary from an Estate or Trust............................. ..............5.
.00
6. Net S hort Term Capital Gains (He ld 6 months or less) (if loss, enter "0")................................6.
.00
7. Net Rental Income (if loss, enter "0")..................... ............... ............... ............... ............... .......7.
.00
8. Other Taxable Income.......... ............... ............... ............... ............... .............................. ...........8.
.00
9. Total Taxable Income (add lines 1 through 8)................. ............... .............................. ..............9.
.00
10. Deductible E xpenses ................. ............... .............................. ............... ............... ............... .10.
.00
11. Total Taxable Income (line 9 less line 10)............. ............... ............... ............... ............... .....11.
.00
12. Gross Tax Due (line 11 tim es .044625).................... ............... ............... ............... ............... 12.
.00
13. Credits or Tax previously paid with an extension coupon..................... ............... ............... ....13.
.00
14. TAX DUE If line 12 is greater than line 13, enter the difference here............................. .......14.
.00
15. If line 13 is greater than line 12, enter the OV ERPAYMENT to be:
.00
A. Ref unded. Do not file a separate Re fund Petition............................ ............... ..........15A .
OR
.00
B. A pplied to the 2005 School Income Tax............................ ............... ............... ..............15B .
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 #____________________
Spouse's Signature_______________________________________ Date________________ Phone #____________________
Preparer Signature________________________________________ Date________________ Phone #____________________
SIT04 NATCP (10/23/ 2004)
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