Annual Reconciliation Of 2011 Employee Earnings Tax - City Of Philadelphia
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1SOCIAL SECURITY NUMBER
CITY OF PHILADELPHIA
6
0
1
1
-
-
ANNUAL RECONCILIATION OF 2011
EMPLOYEE EARNINGS TAX
DUE DATE APRIL 17, 2012
Do not file this return if Philadelphia wage tax was
Taxpayer Name and 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 return. File the Employee Wage Tax
Refund Petition.
The Change Form and Refund Petition can be
downloaded from
YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF ADDRESS
If this is an amended return place an "X" here:
OR TO CANCEL THIS ACCOUNT.
,
,
.00
1. Gross Compensation received in 2011. Enclose 2011 W-2 form(s)...........................1.
.00
,
,
2. Non-taxable gross compensation from Page 2, Line 5................................................2.
.00
,
,
3. Gross taxable compensation (Line 1 minus Line 2)......................................................3.
,
,
.00
4. Taxable Gross Compensation received by a resident of Philadelphia.................4.
.00
,
,
5. Tax Due (Line 4 times .03928)....................................................................................5.
.00
,
,
6. Taxable Gross Compensation received by a non-resident of Philadelphia.........6.
,
,
.00
7. Tax Due (Line 6 times .034985)..................................................................................7.
,
,
.00
8. Total Tax Due (Line 5 plus Line 7)...............................................................................8.
.00
,
,
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.
.00
,
,
10. Net Tax Due (Line 8 minus Line 9)............................................................................10.
11. Tax that you, not your employer, previously paid for 2011.
,
,
.00
(Not included on W-2 forms)......................................................................................11.
.00
,
,
12. ADDITIONAL TAX DUE If Line 10 is greater than Line 11, enter here....................12.
OVERPAYMENT OPTIONS If Line 10 is less than Line 11, enter the amount to be:
.00
,
,
13A. Refunded. Do not file a separate Refund Petition.............................................13A.
OR
,
,
.00
13B. Applied, up to the tax due, to the 2012 Earnings Tax Return.................................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 #_________________________
Page 1
2011 Earnings Internet 10-24-2011 Final
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