Form 531 - Earned Income Tax Return - 2004 Page 2
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1
2%
DATE EMPLOYED
TAXPAYER
TAXPAYER
PAGE 2
W-2 WAGES
A
B
SECTION
DURING THIS TAX YEAR
TAX WITHHELD
EMPLOYER'S NAME
GROSS EARNED INCOME
TAX WITHHELD
GROSS EARNED INCOME
FROM
TO
/
/
/
/
a.
b.
/
/
/
/
c.
/
/
/
/
d.
/
/
/
/
e.
/
/
/
/
f.
/
/
/
/
2
TOTAL. CARRY TO SECTION
LINES 1 & 9
ENCLOSE A W-2 FORM FOR EACH EMPLOYER
CARRY TO LINE 9
CARRY TO LINE 1
CARRY TO LINE 9
CARRY TO LINE 1
ON FRONT SIDE
ON FRONT SIDE
ON FRONT SIDE
ON FRONT SIDE
'
DO NOT
SECTION
OTHER TAXABLE INCOME:
REPORT CAPITAL GAINS OR DIVIDENDS, OR INTEREST
ON SAVINGS OR INVESTMENTS, OR SCHEDULE E INCOME
DESCRIPTION OF WORK OR SERVICE PERFORMED,
AMOUNT
AMOUNT
RECEIVED FROM (PAYOR NAME)
A
B
TAXPAYER
TAXPAYER
EX. TIPS, FEE, 1099 MISC INCOME. ENCLOSE A COPY.
$
$
$
$
TRANSFER SECTION 4 TOTALS TO LINE 3 ON FRONT OF TAX RETURN.
$
$
TOTALS
(
SECTION
West Shore Tax Bureau collects the earned income/ compensation tax and the net profits tax for the following school districts
and municipalities. If you were a resident of any of the listed municipalities and school districts for all or any portion of the tax
year, you are required to file a return with this bureau.
TAX TABLE: TOTAL TAX RATE IS INDICATED BELOW FOR EACH OF THE MEMBER SCHOOL DISTRICTS
CUMBERLAND COUNTY TAXING AUTHORITIES:
CUMBERLAND COUNTY AND YORK COUNTY:
01/01/04 - 06/30/04 = 1% RATE
West Shore School District
1.45%
Camp Hill School District
2%
Effective 07/01/2004
07/01/04 - 12/31/04 = 2% RATE
98252 Fairview Township (NR .5%)*
98220 Goldsboro Borough
98050 Camp Hill Borough (NR 1%)*
98057 Lemoyne Borough (NR 1%)*
01/01/04 - 06/30/04 = 1% RATE
98058 Lower Allen Township (NR 1%)*
Cumberland Valley School District
1.6%
Effective 07/01/2004
07/01/04 - 12/31/04 = 1.6% RATE
98242 Newberry Township I (NR 1%)*
98055 Hampden Township (NR 1%)*
98066 New Cumberland Borough (NR 1%)*
98062 Middlesex Township (NR 1%)*
98083 Wormleysburg Borough (NR 1%)*
98063 Monroe Township (NR 1%)*
YORK COUNTY:
98074 Silver Spring Towhship (NR 1%)*
East Pennsboro School District
1.6%
Northeastern School District
1%
98054 East Pennsboro Township (NR 1%)*
67542 Newberry Township II (NR 1%)*
Mechanicsburg School District
1.7%
Northern York County School District
1.25%
98061 Mechanicsburg Borough (NR 1%)*
67500 Carroll Township
98073 Shiremanstown Borough (NR 1%)*
67507 Dillsburg Borough
98059 Shiremanstown Annex (NR 1%)*
67517 Franklin Township
98078 Upper Allen Township (NR 1%)*
NR-INDICATES MUNICIPALITIES WHO
67518 Franklintown Borough (NR .5%)*
HAVE LEVIED THE NON-RESIDENT TAX.
67536 Monaghan Township (NR 1%)*
*Maryland Residents will receive credit
67560 Warrington Township
upon application by the taxpayer.
67562 Wellsville Borough (NR .5%)*
&
SECTION
SCHEDULE X
COLUMN A
COLUMN B
COLUMN C
COLUMN D
# MONTHS @
# MONTHS
# MONTHS
TOTALS
Column A:
For NORTHEASTERN school district residents, indicate number of months you resided in the school
1% TAX RATE
district during 2004. For residents of CAMP HILL S.D. and CUMBERLAND VALLEY S.D., indicate number
of months you resided within the school district between 01/01/04 and 06/30/04 only.
Column B:
For CAMPHILL S.D. and CUMBERLAND VALLEY S.D. residents, indicate the number of months you
resided within the school district between 07/01/04 and 12/31/04 only.
Column C:
For residents of EAST PENNSBORO S.D.; MECHANICSBURG S.D.; WEST SHORE S.D.; NORTHERN
YORK COUNTY S.D. enter the number of full months you were a resident in your school district during
01/01/04 through 12/31/04.
If you moved between these school districts please put the number of months during 01/01/04 through
06/30/04 in Column B, and also put the number of months during 07/01/04 through 12/31/04 in Column C.
1. W-2 earnings
2. Less employee business expense
3. Other taxable earned income
4. Net loss from business, farm or profession
5. Total taxable earned income
6. Net profit from business, farm or profession
7. Total taxable earned income and net profit (add lines 5 & 6)
8. Tax Liability:
Column A:
1% of line 7 of Form 531 for residents of Northeastern School District; Camp Hill
S.D.; and Cumberland Valley S.D. only.
Column B:
Use applicable rate for 07/01/2004 through 12/31/2004 for Camp Hill S.D. and
Cumberland Valley S.D. residents only.
Column C:
Use applicable tax rate for 01/01/2004 through 12/31/2004 for East Pennsboro
S.D.; Mechanicsburg S.D.; West Shore S.D. and Northern York County S.D. residents.
Column D:
Total of columns A+B+C. Enter the figures from column D onto the front of this
tax return form, and also complete lines 9 through 18 on the front of this tax return form.
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