Final Return For Earned Income & Net Profit Tax For The Year 2011 - Berks Earned Income Tax Bureau
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1
2Due Date:
Berks Earned Income Tax Bureau
April
17, 2012
920 Van Reed Road, Wyomissing, PA 19610
Telephone: 610-372-8439 Toll Free: 1-855-372-8439 Fax: 610-372-1102
FINAL RETURN FOR EARNED INCOME & NET PROFIT TAX FOR THE YEAR 2011
SEE REVERSE SIDE OF THIS FORM AND SEPARATE INSTRUCTIONS & DEFINITONS SHEET
2011
Your Social Securi Number
Spouse's Social Securi Number
Last Name
Your First Name & Middle In~ial
i::pouse s Last Name (II amerent from aDOVe)
II Joint Ketum, ::pouse s i-irst Name & Miaaie iniiiai
i
Physicai Resiaem Aaaress inumoer ana street)
Il;rty, ::tate ana Lip voae
If current address is different Uian above please indicate new address below
You can file on-line at www berkseit CO'll
New
address:
Tax a er A
Souse El
1. Eamed Income frm W-2(s) See instructions
(Enclose W-2(s) Indicating all information from Box 1 through Box 20)
2. Less: Allowable Unrembursed Employee Business Expenses ( instructions)
(Enclose PA UE and Page 1 of Form PA-4)
2
3
3. Other Eamed Income (See instructions
7. TOTAL TAXABLE NET PROFIT (lines 5 minus 6)
NOT LESS THAN ZERO
4. Sub-Total (line 1 minus line 2 plus line 3) Not less than zero
5. Net Profrts from a business, farm, proession, partnership, etc.
Enclose PA Schedules
6. Net Losses from a business, farm, profession, partnership, etc.
(Enclose PA Schedules) (lim~ed to net profrts on line 5)
8. TOTAL TAXABLE EARNED INCOME (add lines 4 & 7)
9. Total Resident Locl
Income Tax (line 8 X Tax a ets resident tax rate)
9
Distressed Commuter Tax (If a licable. See instructions)
10
11. Total Tax Due Add lines 9 and 10
12. Enter Total Local
Income Tax w~hheld on W-2s- (Enclose W-2's - Copies ok)
DO NOT INCLUDE PHILADELPHIA OR OUT OF STATE TAX
11
12
13. 2011 0 estimated payments
201 0 0 prior year cred~
13
14. 0 Philadelphia Cred~
o Out of State Cred~
14
18. Tax Balance Due line 11 minus line 15)
If less than $1 - enter zero
15. Total Cred~s Add lines 12, 13 & 14
16. Overpayment/Refund (line 15 minus 11)
If less than $1 - enter zero
17. Amount of overpaymem to transfer to next yearltransfer to spouse. 0 Next year 0 Spouse
21. Total Amount Due Add lines 18, 19 and 20 DO NOT ROUND OFF
Make Checks payable to "Berks EIT Bureau"
CHECK HERE IF PAYING BY CREDIT CARD (see instructions for details)
I DECLARE, UNDER PENAL TIES PROVIDED BY LAW, THAT THIS RETURN HAS BEEN EXAMINED BY ME AND IS, TO THE BEST OF MY KNOWLEDGE,
A COMPLETE AND ACCURATE RETURN.
Your signature
Spouse's signature
Date
Your phono number
Tax Preparets Signature
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