Scranton Earned Income Tax Return Form - Income Tax Division - 2011

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2011
William L. Courtright
Tax Collector
100 The Mall at Steamtown, Unit 216
EARNED INCOME RETURN
Scranton, PA 18503
SINGLE TAX OFFICE
SCRANTON EARNED INCOME TAX RETURN
(570) 963-6756, Ext. 3
CITY OF SCRANTON & SCRANTON SCHOOL DISTRICT
Office Hours: 8:30 – 5:00
Customer #:
REMIT TO:
WILLIAM L. COURTRIGHT
COLLECTOR OF TAXES
INCOME TAX DIVISION
100 THE MALL AT STEAMTOWN
UNIT 216
SCRANTON, PA 18503
Joint Filing (i.e. combining income, etc.) is NOT PERMITTED.
Name or Address Changes
RESIDENCY STATUS:
Check only one box.
R
NR
P
Resident
Non-Resident
Part Year Resident
NAME:
(must attach legal proof)
ADDRESS:
FROM: ____ /____ /_______ TO: ____ /____ /_______
Social Security #
1
1. Gross Earning reported on attached W-2(s) – Box 18 (No Rounding of Numbers)
2
2. Allowable Non-reimbursed Employee Business expenses (Attach forms)
3. Taxable W-2 earnings (line 1 less line 2)
3
4. Other Income
4
Attach 1099-MISC (if not reported elsewhere), 1099-R Excuding codes 3, 4 and 7
5. Sub Total
(add lines 3 and 4)
5
6. Net Profits
Attach Federal Schedule C, F, E non-passive or K-1
6
7. Total Earned Income subject to this tax (add lines 5 and 6)
7
3.4%
8. Tax Liability
8
9. Payments to date (On Declaration or Quarterly Payment)
9
10. Earned Income Tax Withheld (Per W-2 - Box 19) copy must be attached
10
11. Credit from last year
11
12
12. Other Credits
Miscellaneous
KOZ
Employed In Other State (see back)
13
13. Total of Lines 9 + 10 + 11 + 12
14
14. If credits (line 13) are larger than Tax (line 8)
OVERPAYMENT
NO REFUND OR CREDITS UNDER $1.00
credit to next year
refund
TAX DUE
15
15. If Tax
(line 8) is larger than credits (line 13)
check attached
paid on-line w/ credit card
16
16. Interest and penalty at 1% per month if filed after April 15
17. Total amount due Check Payable to: Collector of Taxes, or
17
On-Line at our website:
)
(if paying on-line, you are still required to submit this form with attachments
Refunds cannot be used against a balance due.
DATE:
DATE:
TAXPAYER SIGNATURE, I DECLARE UNDER PENALTIES PROVIDED
SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER.
FOR BY LAW THAT I HAVE EXAMINED THIS COMPLETE RETURN
AND IT IS TRUE AND CORRECT. TAX RETURN MUST BE SIGNED.
Personal audit may be required if all W-2’s and Federal/State Schedules are not enclosed.

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