Annual Reconciliation Of 2004 Employee Earnings Tax - City Of Philadelphia
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1MAKE NO MARKS IN THIS AREA
Due Date: April 15, 2005
City of Philadelphia
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Annual Reconciliation of
SOCIA L SECURITY NUMB ER
2004 Employee Earnings Tax
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DO NOT STAP LE THIS RETURN
Name
Do not file this return if Philadelphia wage tax was
Address
withheld on all compensation (Line 8 = Line 9). File a
Change Form to cancel this account.
If wage tax was overwithheld by your employer, do not
file this retur n. File the Em ployee Wage Tax Re fund
Pe tition.
The Change Form and Re fund Petition can be
downloaded from
If this is an amended return, check here:
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1. Gros s Compensation received. Enclose 2004 W-2 form (s)................................1.
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2. Non-taxable compensation from Page 2, Line 3..................................................2.
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3. Net taxable compensation (Line 1 minus Line 2).................................................3.
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4. Taxable Compensation received by a resident of Philadelphia.....................4.
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5. Tax Due (Line 4 X .044625).................................................................................5.
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6. Taxable Compensation received by a non-resident of Philadelphia .............6.
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7. Tax Due (Line 6 X .038801).................................................................................7.
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8. Total Tax Due (Add lines 5 and 7).......................................................................8.
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9. Any Philadelphia wage tax withheld by employer per enclosed W-2 forms........9.
If line 8 is equal to line 9, STOP HERE! Do not file this return.
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10. Net Tax Due (Line 8 less Line 9)......................................................................10.
11. Tax that you, not your employer, previously paid for 2004
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(Not included on W-2 forms).............................................................................11.
12. ADDITIONAL TAX DUE If Line 10 is greater than Line 11, enter the
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difference here and pay this amount by April 15, 2005...................................12.
13. If Line 10 is less than Line 11, enter the OVERPAYMENT to be:
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A. Refunded. Do not file a separate Refund Petition................................13A.
OR
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B. Applied to the 2005 Earnings Tax..............................................................13B.
If claiming a refund on line 13A, W-2 forms must accompany this return. Do not file a separate Refund Petition.
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 10-8-2004 Generic
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