Final Return For Earned Income And Net Profit Tax For The Year 2011 - Berks Earned Income Tax Bureau
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1
2Due Date:
Berks Earned Income Tax Bureau
AMENDED
2011
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 & DEFINITIONS SHEET
AMENDED
Your Social Security Number
Spouse's Social Securi Number
Last
Name
Your First Name & Middle Initial
I
Spouse s Last Name (II allerent irom aoove)
f Joint Return, Spouse s First Name & Middle Initial
IPhyslcal Resident Aaaress (numoer ana stree)
I City, Stale ana Lip i;ooe
If CUi rent addrerss IS different tlian above pleas", indicite neii cliUlt:SS below
You caii file all Iiiie cit WWW BERKSLIT COM
New address:
Tax a er A
Souse e
1. Earned Income frm W-2(s) See instructions
(Enclose W-2(s) Indicating all information from Box 1 through Box 20)
2. Less: Allowable Unreimbursed Employee Business Expenses (See instructions)
(Enclose PA UE and Page 1 of Form PA-4)
2
3
3. Other Earned Income See instructions)
4. Sub-Total (Line 1 minus Line 2 plus Line 3) Not less than zero
5. Net Profits frm a business, farm, profession, partnership, etc.
(Enclose PA Schedules)
6. Net Losss frm a business, farm, profession, partnership, etc.
(Enclose PA Schedules) Limited to net profits on line 5)
5
7. TOTAL TAXBLE NET PROFIT (lines 5 minus 6)
NOT LESS THAN ZERO
6
7
8. TOTAL TAXBLE EARNED INCOME add Lines 4 & 7)
9. Total Resident Local
Income Tax (Line 8 X Taxpa ets residerr tax rate)
9
If applicable. See instructions
10
11. Total Tax Due (Add lines 9 and 10
12. Enter Total Locl
Income Tax withheld on W-2s" (Enclose W.2's - Copies ok)
DO NOT INCLUDE PHILAELPHIA OR OUT OF STATE TAX
11
13. 2011 0 estimated payments
2010 0 prior year credit
12
13
14
14. 0 Philadelphia Credit
o Out of State Creit
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)
15. Total Creits (Add Lines 12,13 & 14)
16. Overpayment/Refund Line 15 minus 11)
If less than $1 - errer zero
17. Amount of overpaymerr to transfer to next year/transfer to spouse. 0 Next year 0 Spouse
18. Tax Balance Due (Line 11 minus line 15)
If less than $1 - errer zero
19. Pena after April
17, 2012 (See instructions)
20. Interest after April
17, 2012 (See instructions)
I DECLARE, UNDER PENALTIES 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 phone number
Tax Preparets Signature
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