Quarterly Payment Voucher For Tax Year 2012 - Cumberland County Tax Bureau

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Work
PSD
Name
You are a resident of
QUARTERLY PAYMENT
Reference #
PSD
VOUCHER FOR TAX
YEAR 2012
Due and payable by
Quarter
$
1.
Earned income and/or net profits
Jan. 1 thru March 31.............................................
% RATE*
2.
*Enter tax rate used to calculate estimated tax
x line 1 = amt due
EX. 1%, 1.7% etc..................................................
If you moved enter the effective date:______/______/__________
3.
$
Check here if address change also applies to spouse
Employer Withheld Jan. 1 thru March 31...............
4.
$
Check here to make corrections to Name, Street address, or Resident
TAX DUE (line 2 minus line 3)...............................
Municipality. Make corrections on back of coupon.
5.
Penalty and interest: line 4 multiplied by 1% per
$
month if paid after due date........................................
If you have no earned income, state the reason: retired/homemaker/student/disabled/temporarily
6.
$
unemployed/minor (state age)/other (please specify)________________________________
TOTAL PAYMENT DUE (add lines 5 & 6).......
Check here if ALL tax is withheld by employer(s). Do not complete information requested on
right side of coupon.
Mail to: (use green labels)
Make check
☛
X
Cumberland County Tax Bureau
payable to:
_____________________________________Phone_(____)______________
PO Box 656, Camp Hill, PA 17001-0656
Signature
(717) 761-4900
I DECLARE UNDER PENALTIES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.
Work
PSD
QUARTERLY PAYMENT
Reference #
Name
You are a resident of
PSD
VOUCHER FOR TAX
YEAR 2012
Due and payable by
Quarter
$
1.
Earned income and/or net profits
April 1 thru June 30 .............................................
% RATE*
2.
*Enter tax rate used to calculate estimated tax
x line 1 = amt due
EX. 1%, 1.7% etc..................................................
If you moved enter the effective date:______/______/__________
3.
$
Check here if address change also applies to spouse
Employer Withheld April 1 thru June 30 ...............
4.
$
Check here to make corrections to Name, Street address, or Resident
TAX DUE (line 2 minus line 3)...............................
Municipality. Make corrections on back of coupon.
5.
$
Penalty and interest: line 4 multiplied by 1% per
month if paid after due date........................................
If you have no earned income, state the reason: retired/homemaker/student/disabled/temporarily
6.
$
unemployed/minor (state age)/other (please specify)________________________________
TOTAL PAYMENT DUE (add lines 5 & 6).......
Check here if ALL tax is withheld by employer(s). Do not complete information requested on
right side of coupon.
Mail to: (use green labels)
Make check
☛
X
Cumberland County Tax Bureau
payable to:
_____________________________________Phone_(____)______________
PO Box 656, Camp Hill, PA 17001-0656
Signature
(717) 761-4900
I DECLARE UNDER PENALTIES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.
Work
PSD
Name
You are a resident of
QUARTERLY PAYMENT
Reference #
PSD
VOUCHER FOR TAX
YEAR 2012
Due and payable by
Quarter
$
1.
Earned income and/or net profits
July 1 thru Sept. 30 .............................................
% RATE*
2.
*Enter tax rate used to calculate estimated tax
x line 1 = amt due
EX. 1%, 1.7% etc..................................................
If you moved enter the effective date:______/______/__________
3.
$
Check here if address change also applies to spouse
Employer Withheld July 1 thru Sept. 30 ..............
4.
$
Check here to make corrections to Name, Street address, or Resident
TAX DUE (line 2 minus line 3)...............................
Municipality. Make corrections on back of coupon.
5.
$
Penalty and interest: line 4 multiplied by 1% per
month if paid after due date........................................
If you have no earned income, state the reason: retired/homemaker/student/disabled/temporarily
6.
$
unemployed/minor (state age)/other (please specify)________________________________
TOTAL PAYMENT DUE (add lines 5 & 6).......
Check here if ALL tax is withheld by employer(s). Do not complete information requested on
right side of coupon.
Mail to: (use green labels)
Make check
☛
X
Cumberland County Tax Bureau
payable to:
_____________________________________Phone_(____)______________
PO Box 656, Camp Hill, PA 17001-0656
Signature
(717) 761-4900
I DECLARE UNDER PENALTIES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.
Work
PSD
Name
You are a resident of
QUARTERLY PAYMENT
Reference #
PSD
VOUCHER FOR TAX
YEAR 2012
Due and payable by
Quarter
$
1.
Earned income and/or net profits
Oct. 1 thru Dec. 31.............................................
% RATE*
2.
*Enter tax rate used to calculate estimated tax
x line 1 = amt due
EX. 1%, 1.7% etc..................................................
If you moved enter the effective date:______/______/__________
3.
$
Check here if address change also applies to spouse
Employer Withheld Oct. 1 thru Dec. 31...............
4.
$
Check here to make corrections to Name, Street address, or Resident
TAX DUE (line 2 minus line 3)...............................
Municipality. Make corrections on back of coupon.
5.
$
Penalty and interest: line 4 multiplied by 1% per
month if paid after due date........................................
If you have no earned income, state the reason: retired/homemaker/student/disabled/temporarily
6.
$
unemployed/minor (state age)/other (please specify)________________________________
TOTAL PAYMENT DUE (add lines 5& 6).......
Check here if ALL tax is withheld by employer(s). Do not complete information requested on
right side of coupon.
Mail to: (use green labels)
Make check
☛
X
Cumberland County Tax Bureau
payable to:
_____________________________________Phone_(____)______________
PO Box 656, Camp Hill, PA 17001-0656
Signature
(717) 761-4900
I DECLARE UNDER PENALTIES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.

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