Form Fr 1 - Final Individual Earned Income Tax Return - Parkland School District - 2011
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1
2FORM FR 1
PARKLAND SCHOOL DISTRICT
REFER TO INSTRUCTIONS
EARNED INCOME TAX OFFICE
ON REVERSE SIDE
P.O. BOX 200, OREFIELD, PA 18069-0200
2011
PHONE 610-351-5570
FOR CALENDAR YEAR
FINAL INDIVIDUAL EARNED INCOME TAX RETURN
(File this return with the Income Tax Officer on or before April 15, 2012. Any balance of tax (ITEM 8) shall be paid in full with return.)
IF YOU HAVE MOVED WITHIN THE ABOVE YEAR, PLEASE COMPLETE THIS SECTION.
CURRENT ADDRESS
DATE MOVED
FORMER ADDRESS
DATE MOVED
(PLEASE MAKE ANY NECESSARY CORRECTIONS)
NAME
OCCUPATION
ADDRESS
RESIDENT TOWNSHIP
(1) ENTER YOUR GROSS EARNINGS AS REPORTED ON FORM W2(s)
PRINT EACH EMPLOYER’S NAME AND LOCAL ADDRESS
$
IF MORE SPACE
NEEDED PLEASE
$
ATTACH A
SEPARATE SHEET
$
A COPY OF FORM W-2 AND/OR 1099 FOR EACH EMPLOYER MUST BE ATTACHED
(1A) LESS UNREIMBURSED EXPENSES, IF ANY, AS REPORTED ON
FORM PA UE
$
A COPY OF PA FORM UE MUST BE ATTACHED
(1B) ENTER TOTAL HERE
$
NOT LESS THAN ZERO
(2)
COMBINED NET PROFIT AND NET LOSS FROM BUSINESS OR PROFESSION
FROM
FORM PA 40 SCHEDULE PA-C, F, OR RK-1
$
SEE REVERSE SIDE, ITEM B2, FOR INSTRUCTIONS
A COPY OF ALL SCHEDULES MUST BE ATTACHED
(3) TOTAL TAXABLE INCOME (ITEM 1B PLUS 2)
$
YOUR TAX (1% OF LINE 3)
(4)
$
(5)
AMOUNT PAID:
A.
BY WITHHOLDING FROM YOUR WAGES – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – $
B.
BY PAYMENTS ON YOUR ESTIMATED TAX – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – $
C.
BY PAYMENTS TO OTHER STATE OR POLITICAL SUBDIVISION – – – – – – – – – – – – – – – – – – – – – – $
SEE REVERSE SIDE, ITEM B6, FOR INSTRUCTIONS
(ITEM 5D) ENTER TOTAL OF 5A, 5B, AND 5C HERE
$
OVERPAYMENT
(6)
IF YOUR PAYMENTS (ITEM 5D) ARE LARGER THAN YOUR TAX (ITEM 4) ENTER
HERE
$
2012
CHECK (X) IF YOU WANT THIS OVERPAYMENT
OR CREDITED TO YOUR
REFUNDED TO YOU
ESTIMATED TAX
BALANCE OF TAX DUE
(7)
IF YOUR TAX (ITEM 4) IS LARGER THAN (ITEM 5D) ENTER
HERE
$
(7A) AFTER APRIL 15 ADD 1% INTEREST AND PENALTY CHARGES PER MONTH OF LINE 7
$
SEE REVERSE SIDE, B4, IF AN IRS EXTENSION HAS BEEN FILED.
MAKE CHECKS PAYABLE TO
“PARKLAND SCHOOL DISTRICT”
(8)
TOTAL PAYMENT DUE WITH THIS RETURN (LINE 7 PLUS LINE 7A)
$
I DECLARE, UNDER PENALTIES OF PERJURY, THAT THIS RETURN HAS BEEN PREPARED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF, IS A TRUE, CORRECT, AND COMPLETE FORM.
THIRD PARTY
DO YOU WANT TO ALLOW ANOTHER PERSON TO DISCUSS THIS RETURN WITH THE PARKLAND TAX OFFICE
YES
NO
DESIGNEE
DESIGNEE’S NAME
PHONE NO. (
)
DATE
SIGNATURE OF TAXPAYER
PLEASE COMPLETE THE FOLLOWING IF PREPARED BY OTHER THAN TAXPAYER
DATE OF PREPARATION
NAME / COMPANY OF PREPARER
SIGNATURE OF PREPARER
ADDRESS
THIS FORM MUST BE FILED WHETHER YOUR TAX HAS BEEN WITHHELD OR NOT
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