School Income Tax Form - City Of Philadelphia - 2011

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CITY OF PHILADELPHIA
DUE DATE: APRIL 17, 2012
2011 SCHOOL INCOME TAX
4
3
1
1
Your Social Security Number
Taxpayer Name and Address
Spouse's Social Security Number
If this is an amended return place an "X" here.
YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF
mm-dd-yyyy
mm-dd-yyyy
to
If you were a partial year resident in 2011, refer to page 1 and enter dates of residency here:
mm-dd-yyyy
If you no longer have income subject to School Income Tax enter the termination date AND file a CHANGE FORM.
.00
1. Net Taxable Dividends (School Income Tax Regulation 203(a)).........................................1.
.00
2. Taxable Interest (Reg. 203(b)).............................................................................................2.
.00
3. "Subchapter S" Corporation (Reg. 203(a)). If loss, enter "0" (zero)....................................3.
.00
4. Limited Partnership Income (Reg. 203(i)). If loss, enter "0" (zero)......................................4.
.00
5. Taxable Income received by a Beneficiary of an Estate or Trust (Reg. 205).......................5.
.00
6. Net Short Term Capital Gains (held 6 months or less) If loss, enter "0" (zero)................6.
.00
7. Net Rental Income (Reg. 203(c)). If loss, enter "0" (zero)...................................................7.
.00
8. Other Taxable Income (Reg. 203(e, f, g and h))..................................................................8.
.00
9. Total Taxable Income (Add lines 1 through 8).....................................................................9.
.00
10. Deductible Expenses (Reg. 204(a))...................................................................................10.
.00
11. Net Taxable Income (Subtract line 10 from line 9).............................................................11.
.00
12. Gross Tax Due (Multiply line 11 by .039280).....................................................................12.
.00
13. Credit from overpayment of prior year or tax previously paid by extension.......................13.
.00
14. TAX DUE If Line 12 is greater than Line 13, enter the difference here ............................14.
OVERPAYMENT OPTIONS If Line 12 is less than Line 13, enter the amount to be:
.00
15A. Refunded. Do not file a separate Refund Petition......................................................15A.
OR
.00
15B. Applied to the 2012 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 #_________________________
4311 Web 8-17-2012

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